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BULLETIN 

OF  THE 

University  of  Maryland  School  of  Medicine 

AND 

College  of  Physicians  and  Surgeons 

Successor  to  The  Hospital  Bulletin,  of  the  University  of  Maryland, 
Baltimore  Medical  College  News,  and  the  Journal  of  the  Alumni  Asso- 
ciation of  the  College  of  Physicians  and  Surgeons. 


Vol.  VI 


JULY,  1921 


]^o.  1 


ANNUAL  ANNOUNCEMENT. 
SESSION  1921-1922 


CALENDAR 


1921-1922. 

SCHOOL  OF  MEDICINE. 

September  19  to  24,  Inc. — Examiuations  for  advanced  staudiug. 

October  3 — Regular  session  begins. 

November  24 — Closed   (Thanksgiving  Day). 

December  21 — Christmas  recess  begins  after  last  lecture  period. 

January  4 — Lectures  resumed  9  A.  M. 

February  22 — Closed  (Washington's  Birthday). 

April  13 — Easter  recess  begins  after  last  lecture  period 

April  IS — Lectures  resumed.     9  A.  M. 

June  1 — Commencement. 


OEGA^S^IZATIOjN' 


THE    UNIVERSITY  OF  MARYLAND 

Control  of  the  University  of  Maryland  is  vested  in  a  Board  of 
nine  Regents,  appointed  by  the  Governor  and  confirmed  by  the 
Senate  for  terms  of  nine  years  each.  The  General  administration 
of  the  University  is  vested  in  the  President.  The  University 
Council  is  an  advisory  body,  composed  of  the  President,  the 
Assistant  to  the  President,  the  Director  of  the  Agricultural 
Experiment  Station,  the  Director  of  the  Extension  Service,  and 
the  Deans.  The  University  Council  acts  upon  all  matters  having 
relation  to  the  University  as  a  whole,  or  to  co-operative  work 
between  the  constituent  groups.  Each  school  has  its  own  Faculty 
Council,  composed  of  the  Dean  and  members  of  its  faculty ; 
each  Faculty  Council  controls  the  internal  affairs  of  the  group  it 
represents. 

The  University  has  the  following  educational  organization : 
The  College  of  Agriculture, 
The  School  of  Engineering, 
The  School  of  Liberal  Arts, 
The  School  of  Medicine, 
The  School  of  Law, 
The  School  of  Dentistry, 
The 'School  of  Pharmacy, 
The  School  of  Education, 
The  School  of  Chemistry, 
The  School  of  Home  Economics, 
The  Graduate  School, 
The  Summer  School, 

The  Department  of  Military  Science  and  Tactics, 
The  Department  of  Physical  Education  and  Recreation. 

The  Schools  of  Medicine,  Law,  Dentistry  and  Pharmacy  are 
located  in  Baltimore;  the  others  in  College  Park,  Marvlaud. 


BOARD  OF  REGENTS 

OF   THE 

UNIVERSITY  OF  MARYLAND. 

Samuel  M.  Shoemakeb,  Esq.,  Chairman Term  expires  1925 

Robert  Grain,  Esq Term  expires  1924 

John  M.  Dennis,  Esq.,  Treasurer Term  expires  1923 

Dr.  Frank  J.  Goodnow Term  expires  1922 

John  E.  Raine,  Esq Term  expires  1921 

C.  C.  Gelder.  Esq Term  expires  1920 

Dr.  W.  W.  Skinner,  iiecretary Term  expires  1919 

B.  John  Black,   Esq Term  expires  1926 

Henry  Holzapfel,  Jr.,  Esq Term  expires  1927 


Albert  F.  Woods,  A.M.,  D.Agr.,  President  and  Executive  Officer. 


THE  UNIVERSITY  COUNCIL, 

Albert  F.  Woods.  A.M..  D.Agr President 

H.  C.  Byrd,  B.S Assistant  to  the  President 

P.  W.  Zimmerman.  M.8 Dean  of  the  College  of  Agriculture 

T.  H.  Talliaferro,  C.E.,  Ph.D Dean  of  the  School  of  Engineering 

Frederick  E.  Lee,  Ph.D Dean  of  the  School  of  Liberal  Arts 

Henry  D.  Harlan,  LL.D Dean  of  the  School  of  Law 

J.  M.  H.  Rowland,  M.D Dean  of  the  School  of  Medicine 

E.  Frank  Kelly,  Phar.D Dean  of  the  School  of  Pharmacy 

T.  O.  Heatwole,  M.D.,  D.D.S Dean  of  the  School  of  Dentistry 

R.  P.  Cotterman,  M.S Dean  of  the  School  of  Education 

H.  B.  McDonnell.  M.S..  M.D .Dean  of  the  School  of  Chemistry 

M.  Marie  Mount,  A.B Acting  Dean  of  the  School  of  Home  Economics 

G.  O.  Appleman,  Ph.D Dean  of  the  Graduate  School 

H.  J.  Patterson,  D.S.C Director  of  the  Experiment  Station 

Thomas  B.  Symons.  M.S..  D.Agr Director  of  Extension  Service 


UNIVERSITY  OF  MARYLAND 
SCHOOL  OF  MEDICINE 

AND 

COLLEGE  OF  PHYSICIANS  AND 
SURGEONS. 


MEDICAL  COUNCIL: 

ARTHUR  M.  SHIPLEY,  M.D. 

GORDON  WILSON,  M.D. 

HARRY  FRIEDENWALD,  A.B.,  M.D. 

WILLIAM  S.  GARDNER,  M.D. 

STANDI  SH  McCLEARY,  M.D. 

JULIUS  FRIEDENWALD,  A.M.,  M.D. 

J.  M.  H.  ROWLAND,  M.D. 

ALEXIUS  McGLANNAN,  A.M.,  M.D. 

BARTGIS  McGLONE,  A.B.,  Ph.D. 
HUGH  R.  SPENCER.  M.D. 

H.  BOYD  WYLIE,  M.D. 

CARL  L.  DAVIS.  M.D. 

WILLIAM  H.   SCHULTZ.  Ph.B..  Ph.D. 


BOARD  OF  INSTRUCTION 


BOARD  OF  INSTRUCTION. 

EMERITUS  PROFESSORS. 

Randolph  Win  slow,  A.M.,  M.D.,  LL.D Surgery 

Samuel  K.  Mereick.  M.D Rhinology  and  Laryngology 

(lEORGE  W.  Dobbin,  A.B.,  M.D Obstetrics 

HiKAM  Woods,  A.M.,  M.D Opthalmology  and  Otology 

Charles  G.  Hill,  A.M.,  M.D Psychiatry 

A,  C.  Pole,  M.D Anatomy 

J.  Frank  Crouch,  M.D Clinical  Oiilithalmology  and  Otology 

Charles  O'Donovan,  A.M.,  M.D.,  LL.D. .  .Clinical  Medicine  and  Pediatrics 

John  R.  Winslow.  A.B.,  M.D Rhinology  and  Laryngology 

Edward  N.  Brush,  M.D Psychiatry 


L.  E.  Neale,  M.D.,  LL.D.,  Professor  of  Obstetric!<. 

John  C.  Hemmeter,  M.D..  Ph.D.,  Sc.D.,  LL.D..  Professor  of  Clinical  Med- 
icine. 

Arthur  M.  Shipley,  M.D.,  Professor  of  Surgery. 

Gordon  Wilson,  M.D.,  Professor  of  Medicine. 

William  Royal  Stokes,  M.D.,  Sc.D.,  Professor  of  Bacteriology. 

Harry  Friedenwald,  A.B.,  M.D.,  Professor  of  Opthalmology  and  Otology. 

Archibald  C.  Harrison,  M.D.,  Professor  of  Surgery. 

Cary  B.  Gamble,  Jr.,  A.  M.,  M.D..  Professor  of  Medicine. 

William  S.  Gardner,  M.D.,  Professor  of  Gynecology. 

Standish  McCleary,  M.D.,  Professor  of  Pathology  and  Clinical  Medicine. 

Julius  Friedenwald,  A.M.,  M.D.,  Professor  of  Gastro-Enterology. 

J.  M.  H.  Rowland,  M.D.,  Professor  of  Obstetrics  and  Dean  of  the  Faculty. 

Alexius  McGlannan,  A.M.,  M.D.,  Professor  of  Surgery. 

Thomas  C.  Gilchrist,  M.R.C.S..  L.S.A..  M.D.,  Professor  of  Dermatology. 

G.  Milton  Linthicum,  A.M..  M.D.,  Professor  of  Diseases  of  the  Rectum 
and  Colon. 

W.  B.  Perry,  M.D.,  Professor  of  Clinical  Gynecology. 

Tilghman  B.  Marden,  A.B..  M.D..  Professor  of  Histology  and  Embryology. 

J.  Mason  Hundley,  M.D.,  Professor  of  Clinical  Gynecology. 

R.  Tunstall  Taylor,  A.B.,  M.D.,  Professor  of  Orthopedic  Surgery. 

Jos.  E.  GicHNER,  M.D.,  Professor  of  Clinical  Medicine  and  Physical  Thera- 
peutics. 

Charles  AY.  McElfresh,  M.D.,  Professor  of  Clinical  Medicine. 

Irving  J.  Spear,  M.D..  Professor  of  Neurology  and  Clinical  Psychiatry. 

C.  Hampson  Jones,  M.D.,  CM.  (Edinlmrgb  ».  M.r>..  Professor  of  Hygiene 
and  Public  Health. 

John  Ruhrah.  M.D.,  Professor  of  Pediatrics. 

Charles  F,  Bl.^ke,  A.M.,  M.D..  Professor  of  Proctology. 

Frank  Dyer  Sanger,  M.D.,  Professor  of  Diseases  of  Throat  and  Nose. 


BOAED  OF  INSTRUCTION  7 

Babtgis  McGlone,  A.B.,  Ph.D.,  Professor  of  Physiology. 

H.  R.  Spencer,  M.D.,  Professor  of  Pathology. 

H.  Boyd  Wylie.  M.D.,  Professsor  of  Physiological  Chemistry. 

Cabl  L.  Davis.  Professor  of  Anatomy. 

W.  L.  ScHrLTz,  Ph.B.,  Ph.D.,  Professor  of  Pharmacology. 

S.  Griffith  Davis,  A.B.,  M.D.,  Professor  of  Anaesthesia. 

G.  Carroll  Lockard,  M.D.,  Professor  of  Clinical  Medicine. 

Charles  E.  Brack,  Ph.G.,  M.D.,  Professor  of  Clinical  Obstetrics. 

Harvey  G.  Beck,  M.D.,  Sc.D.,  Professor  of  Clinical  Medicine. 

Albertxjs  Cotton,  A.M.,  M.D.,  Professor  of  Orthopedic  Surgery  and  Roent- 
genology. 

Andrew  C.  Gillis,  A.M.,  M.D.,  Professor  of  Neurology  and  Clinical 
Phychiatry. 

Joseph  H.  Branham,  M.D.,  Professor  of  Clinical  Surgery. 

Bernard  Purcell  Muse,  M.D.,  Professor  of  Clinical  Obstetrics. 

Wm.  T.  Watson,  M.D.,  Professor  of  Therapeutics. 

Charles  L.  Summers,  M.D.,  Professor  of  Pediatrics. 

Anton  G.  Rytina,  A.B.,  M.D.,  Professor  of  Genito-Frinary  Diseases. 

Henry  J.  Walton,  M.D.,  Professor  of  Roentgenology. 

Nathan  Winslow.  A.M.,  M.D.,  Cinical  Professor  of  Surgery. 

Page  Edmunds.  M.D.,  Clinical  Professor  of  Genito-Urinary  Diseases. 

Walter  D.  Wise,  M.D.,  Clinical  Professor  of  Surgery. 

Edgar  B.  Friedenwald,  M.D.,  Clinical  Professor  of  Pediatrics. 

Compton  Riely',  M.D.,  Clinical  Professor  of  Orthopedic  Surgery. 

Sydney  M.  Cone,  A.B.,  M.D.,  Clinical  Professor  of  Orthopedic  Surgery 
and  Associate  in  Pathology. 

W.  S.  Smith,  M.D.,  Clinical  Professor  of  Gynecology. 

Joseph  W.  Holland,  M.D.,  Clinical  Professor  of  Surgery. 

A.  J.  Underhill,  A.B.,  M.D.,  Clinical  Professor  of  Genito-Urinary  Diseases. 

E.  B.  Freeman,  B.S.,  M.D.,  Clinical  Professor  of  Gastro-Enterology. 

J.  C.  Lumpkin,  M.D.,  Clinical  Professor  of  Surgery. 

T.  Feed  Leitz,  M.D.,  Clinical  Professor  of  Gastro-Enterology. 

J.  W.  Downey.  M.D..  Clinical  Professor  of  Otology. 

Hugh  Brent.  M.D.,  Associate  Professor  of  Gynecologj\ 

Melvin  Rosenthal,  M.D.,  Associate  Professor  of  Genito-Urinary  Surgery 
and  Dermatology. 

Hubert  C.  Knapp,  M.D.,  Associate  Professor  of  Medicine. 

Abraham  Samuels,  Ph.G.,  M.D.,  Associate  Professor  of  Gynecology. 

Whxiam  W.  RequaSdt,  M.D.,  Associate  Professor  of  Surgery. 

George  W.  Mitchell,  M.D.,  Associate  Professor  of  Diseases  of  Throat  and 
Nose. 

Lewis  J.  Rosenthal,  M.D.,  Associate  Professor  of  Proctology. 

J.  R.  Abercrombie,  A.B.,  M.D.,  Associate  Professor  of  Dermatology. 

C.  C.  CoNSER.  M.D.,  Associate  Professor  of  Physiology. 

H.  J.  Maldeis,  M.D..  Associate  Professor  of  Medical  Jurisprudence. 

J.  Dawson  Reeder,  M.D.,  Associate  Professor  of  Proctology. 


8  BOARD  OF  INSTRUCTION 

H.  C.  Blake,  M.D.,  Associate  Professor  of  Clinical  Surgery. 

Frank  S.  Lynn,  M.D.,  Associate  Professor  of  Surgery. 

G.  M.  Settle,  A.B.,  M.D.,  Associate  Professor  of  Neurology  aud  Clinical 

Medicine. 
C.  C.  W.  JuDU,  A.B.,  M.D.,  Associate  Professor  of  Medicine. 
Elliott  H.  Hutchins.  A.B..  M.I).,  Associate  Professor  of  Surgery 
Thomas  R.  Chambers,  A.B.,  M.D.,  Associate  Professor  of  Surgery. 
R.  W.  LocHER,  M.D.,  Associate  Professor  of  Operative  and  Clinical  Surgery. 
H.  D.  McCarty,  M.D.,  Associate  Professor  of  Clinical  Medicine. 
O.  Glenn  Harne,  A.B.,  Associate  Professor  of  Pharmacology. 
John  Evans,  M.D.,  Associate  Professor  of  Roentgenology. 
Clyde  A.  Clapp,  M.D..  Associate  Professor  of  Ophthalmology  and  Otology. 
Edward  A.   Looper,  M.D..  D.Oph.,   Associate   Professor  of  Ophthalmology 

and  Otology. 
J.  F.  Lutz,  A.B.,  M.D.,  Associate  Professor  of  Clinical  Pathology. 

F.  W.  Hachtel,  M.D.,  Associate  Professor  of  Bacteriology. 
R.  M.  Chapman,  M.D.,  Associate  Professor  of  Psychiatry. 
Wm.  J.  Caeson,  Associate  Professor  of  Pathology. 

Wm.  H.  Smith.  M.D.,  Associate  in  Clinical  Medicine. 

E.  H.  Hayward.  M.D.,  Associate  in  Gynecology. 

R.  C.  Metzel,  M.D.,  Associate  in  Clinical  Medicine. 

John  E.  O'Neill,  M.D.,  A.ssoGiate  in  Clinical  Medicine. 

Geo.  a.  Strauss,  Jr..  M.D.,  Associate  in  Gynecology. 

H.  K.  Fleck,  M.D.,  Associate  in  Ophthalmology  and  Otology. 

Joseph  I.  Kemler,  M.D.,  Associate  in  Ophthalmology  and  Otology. 

Henry  T.  Collenberg,  A.B.,  M.D..  Associate  in  Clinical  Pathology. 

G.  F.  Sargent,  M.D.,  Associate  in  Neurology  and  Clinical  Psychiatry. 
George  Murgatroyd.  M.D..  Associate  in  Rhinology  and  Laryngology. 
J.  Harry  Ullrich.  M.IK,  Associate  in  Gastro-Enterology. 

J.  McF.  Bergland,  M.D.,  Associate  in  Obstetrics.  v 

R.  G.  WiLLSE,  M.D.,  Associate  in  Gynecology. 

Sam'l  W.  Moore,  D.D.S.,  As.sociate  in  Anaesthesia. 

Frank  J.  Kirby,  M.D.,  Associate  in  Surgery. 

Harry  M.  Robinson.  M.D..  Associate  in  Dermatology. 

Theodore  Morrison.  M.D.,  Associate  in  Gastro  Enterology. 

L.  H.  Douglass,,  M.D..  Associate  in  Obstetrics. 

W.  F.  ZiNN,  M.D.,  Associate  in  Nose  and  Throat. 

W.  I.  Messick,  M.D. .Associate  in  Clinical  Medicine. 

M.  Randolph  Kahn,  M.D..  Associate  in  Ophthalmology. 

E.  A.  Knorr,  M.D.,  Associate  in  Ophthalmology. 

W.  H.  Daniels,  M.D..  Demonstrator  of  Orthopedic  Surgery. 
W.  Arthur  Darby.  M.D.,  Demonstrator  of  Orthopedic  Surgery 
R.  L.  Mitchell.  M.D.,  Instructor  in  Gynecology. 
Benjamin  Pushkin.  M.D..  Instructor  in  Neurology. 

F.  L.  Jennings,  M.D.,  Instructor  in  Surgery. 
E.  E.  Mayer.  M.D..  Instructor  in  Medicine. 
W.  G.  Queen,  M.D.,  Instructor  in  Anaesthesia. 


BOARD  OF  INSTRUCTION 

Hakris  Goldman,  M.D.,  Instructor  iu  Urology. 
George  McLean,  M.D.,  Instructor  in  Medicine. 

D.  CoBBiN  Streett,  M.D.,  Instructor  in  Clinical  Medicine. 

A.  M.  Evans,  M.D.,  Instructor  in  Surgery. 

C.  C.  Habliston,  M.D.,  Instructor  in  Clinical  Medicine. 

KicHARD  Dresser,  M.D.,  Instructor  in  Patliology. 

C.  L.  JosLiN,  M.D.,  Instructor  in  Pediatrics. 

W.  H.  TouLsoN,  M.S.,  M.D.,  Instructor  in  Urology. 

Maurice  Feldman,  M.D.,  Instructor  in  Gastro  Enterology. 

Charles  Keid  Edwards,  M.D.,  Instructor  in  Surgery. 

Harold  E.  Wright,  M.D.  Instructor  in  Physiology. 

Frank  N.  Ogden,  M.D.,  Instructor  in  Physiological  Chemistry. 

Martin  Sloan,  M.D.,  Instructor  in  Medicine. 

E.  S.  Johnson,  M.D.,  Instructor  in  Surgery. 
Harry  M.  Stein,  M.D.,  Instructor  in  Medicine. 
M.  J.  Hanna,  M.D.,  Instructor  in  Anatomy. 

L.  A.  M.  Krause,  M.D.,  Instructor  in  Clinical  Pathology. 

H.  M.  Foster,  M.D.,  Instructor  in  Surgery. 

FiBMADGE  K.  Nichols,  A.B.,  M.D.,  Instructor  in  Physiology. 

E.  p.  Smith,  M.D.,  Assistant  in  Operative  Surgery, 
John  S.  Fenby,  M.D.,  Assistant  in  Pediatrics. 

J.  A.  Skladowsky,  M.D.,  Assistant  in  Neurology. 
John  Houtf,  M.D.,  Assistant  in  Pediatrics. 

F.  K.  Kearney,  M.D.,  Assistant  in  Surgery. 
T.  K.  Galvin,  M.D.,  Assistant  iu  Gynecology. 

G.  W.  Bowden,  M.D.,  Assistant  in  Surgery. 

F.  H.  Machin.  M.D.,  Assistant  in  Obstetrics. 
Horace  Byers,  M.D.,  Assistant  in  Medicine. 
Joseph  E.  Gately,  M.D.,  Assistant  in  Dermatologj'. 
DwiGHT  MoHR,  M.D.,  Assistant  in  Surgery. 

H.  R.  Lickle,  M.D.,  Assistant  in  Medicine. 
Wm.  Michel,  M.D.,  Assistant  in  Medicine. 

G.  L.  Zimmerman,  M.D.,  Assistant  in  Medicine. 
J.  G.  M.  Reese,  M.D.,  Assistant  iu  Obstetrics. 
Amos  Hutchins,  M.D.,  Assistant  in  Surgery. 
W.  H.  Ingram,  M.D.,  Assistant  in  Pediatrics. 

B.  J.  Ferry.  M.D.,  Assistant  in  Pediatrics. 
H.  H.  Warner,  M.D.,  Assistant  in  Pediatrics. 
J.  F.  Hawkins,  M.D.,  Assistant  in  Pediatrics. 
Joseph  Sindler,  M.D.,  Assistant  in  Gastro-Enterology. 
MiLFORD  Levy.  M.D.,  Assistant  in  Neurology. 

B.  T.  Baggott,  M.D.,  Assistant  in  Medicine. 

J.  W.  Martindale,  M.D.,  Assistant  in  Medicine. 

C.  A.  Reifschneider.  M.D.,  Assistant  in"  Surgery. 
W.  R.  Gerathy.  M.D.,  Assistant  in  Surgery. 

S.  Demarco,  M.D.,  Assistant  in  Surgery. 
Jack  M.  Hundley,  M.D.,  Assistant  in  Surgery. 


10 


rXIVERSTTY  HOSPITAL  STAFF 


().  n.  Lloyd,  M.D..  Assistant  in  Surj^ery. 

Clyde  N.  Marvel.  M.D.,  Assistant  in  Surgery. 

EvEBARD  Briscoe,  M.D..  Assistant  in  Surgery. 

W.  J.  Todd.  M.D..  Assistant  in  Pediatrics. 

I'KRCY  B.  Hardcastle.  M.D..  Assistant  in  Pediatrics. 

John  H.  Tbaband.  M.D..  Assistant  in  Pediatrics. 

C.  E.  GoLDSBOROuciii.  M.D..  Assistant  in  Pediatrics. 

SrsANNE  Parsons,  A.B.,  M.D.,  Ph.D.,  Assistant  in  Obstetrics 

L.  K.  Fargo,  M.D..  Assistant  in  Genito-Frinary  Diseases. 


UNIVERSITY  HOSPITAL  STAFF. 

Siirffcons. 

Randolph  Winslow.  A.M..  M.D.,  LL.D.  Arthir  M.  Shipli  y.  M.r>. 

Joseph  W.  Holland,  M.D.  Page  Edmunds,  M.D. 

Nathan  Winslow,  A.M.,  M.D.  Frank  S.  Lynn.  M.I». 

Phi/sicians. 

Gordon  Wilson,  M.D.  G.  Carroll  Lockard.  M.Ik. 

Charles  W.  McElfresh.  M.D.  Jos.  E.  Gichner.  M.D. 

EoscoE  C.  Metzel.  M.D.  Wm.  H.  Smith.  M.D. 

Gantro  Enterologists. 
JuLHTs  Friedenwali).  A.M..  M.D.  John  C.  Hemmeter,  Ph.D..  M.D. 

()l)hthalm()h)gi>it>^  and  Otolof/ists. 

Harry  Friedenwald,  M.D. 

William  Tarun.  M.D.  Hiram  Woods.  A.M..  M.E>. 

E.  A.  LooPER,  M.D. 

Lari/ngoloffist. 
Edward  A.  Looper.  M.D. 

Proctologisis. 
G.  Milton  Linthicltm.  A.M..  M.D.  J.  Dawson  Reeder.  M.D. 

(hthopf'dic  i^urgeonsi. 
R.  TuNSTALL  Taylor.  .\.B.,  M.D.  Compton  Riely.  M.D. 

yeurologisi. 
Irving  J.  Spear.  M.I>. 


(Icnito-Uriuar!)  i^urgcoufi. 
A.  J.   I'NDERHILL.  A.B..  M.D.  Page  Edmixds.  M.r>. 


U::^IVERSITY  HOSPITAL  STAFF  11 

•  Pediatrician. 

Charles  L.  Summers,  M.D. 

Pathologists. 

Standish  McCleaby,  M.D.  Hugh  R.  Spencer.  M.D. 

H.  J.  Maldeis,  M.D. 

Roc  ntgeno  logis  t. 
Henry  J.  Walton,  M.D. 


RESIDENT  STAFF. 
Kenneth  B.  Jones,  M.D.,  Medical  Superintendent. 

Resident  tiurgcon. 
C.  C.  Horine,  M.D. 

Resident  Gynecologist. 
L.  H.  Brumback.  M.D. 

Resident  Physician. 
F.  A.  HoLDEN,  M.D. 

Resident  Obstetrician. 
J.  G.  M.  Reese,  M.D. 

Resident  Pediatrician, 
George  E.  Wells,  M.D. 

Assistant  in  Outdoor  Obstetrics. 
L.  J.  Rigney,  M.D. 

Dental  Interne. 
Joseph  W.  Voelker. 

Internes. 

L.  FREEiDOM,  M.D.  G.  R.  Joyner,  M.D. 

C.  F.  Fisher,  M.D.  D.  S.  Fishek.  M.D. 

A.  V.  McCoy,  M.D.  S.  H.  Culver,  M.D. 

J.  T.  Sowers,  M.D.  V,  Joska,  M.D. 

T.  P.  CVRourke,  M.D.  J.  W.  Seay,  M.D. 

R.  J.  Plyler,  M.D.  J.  W.  GUYTON,  M.D. 

R.  J.  Kemp,  M.D. 


12 


UNIVERSITY  HOSPITAL  DISPENSARY  STAFF 

UNIVERSITY  HOSPITAL  DISPENSARY  STAFF. 

J.  A.  Skladowsky,  M.D.,  Dispensary  Physician. 
Miss  G.  McKereghan,  Head  Nurse. 


H.  M. 
D.  CoRBiN  Stbeett,  M.D. 
H.  R.  LiCKLE,  M.D. 
Horace  Byebs,  M.D. 


Medicine. 
Stein,  M.D.,  Chief  of  Clinic. 

S.  R.  Clabke.  M.D. 

G.  L.  Zimmebman,  M.D. 

Wm.  Michel,  M.D. 
W.  G.  Clopton,  M.D. 


Surgery. 
Fbank  S.  Lynn,  M.D..  Chief  of  Clinic. 
H.  M.  Foster,  M.D.  C.  R.  Edwards,  M.D. 

W.  R.  Johnson,  M.D.  E.  S.  Pebkins,  M.D. 

E.  S.  Johnson,  M.D.  D.  E.  Fay,  M.D. 

C.  A.  Reifschneideb,  M.D. 

Pediatrics. 

Charles  L.  Summebs,  M.D.,  Professor  of  Pediatrics. 

C.  L.  JosLiN,  M.D.,  Chief  of  Clinic. 

J.  F.  IiAWKix.s,  M.D. 
Wm.  G.  Todd,  M.D. 
H,  H.  Wabnee,  M.D. 
Peibcy  p.  Hardt,  M.D. 


J.  S.  Fenby.  M.D. 
B.  J.  Febby,  M.D, 
John  Houff,  M.D. 

W.   H.   INGBAM,   M.D, 

John  H.  Tbaband,  M.D. 


C.  R.  Goldsborough.  M.D. 


Gynecology. 
R.  G.  Willse,  M.D.,  Chief  of  Clinic. 


R.  L.  Mitchell,  M.D. 
T.  K.  Galvin,  M.D. 


J.  M.  Hundley,  Jr..  M.D. 
Nathan  Winslow.  M.D. 


Geo.  A.  Stbauss,  M.D. 


Obstetrics. 

L.  H.  Douglass,  M.D.,  Chief  of  Clinic. 

F.  H.  Machin,  M.D. 

Eye  and  Ear. 

Harry  Fbiedenwald,  M.D.,  Professor  of  Ophthalmology  and  Otology. 

H.  L.  SiNSKY,  M.D..  Chief  of  Clinic. 


Nose  and  Throat. 
E.  A.  LooPER,  M.D..  Chief  of  Clinic. 


E.  Mubg.xteoyd.  M.D. 


F.  B.  Andebson.  M.D. 


MERCY  HOSPITAL  STAFF.  13 

Skin. 

H.  M.  Robinson.  M.D.,  Chief  of  Clinic. 

J.  E.  Gately,  M.D.  J.  A.  BxrcHNEss,  M.D, 

Stomach. 
J.  H.  UrxBicH,  M.D.,  Chief  of  Clinic: 

Orthopedics. 

R.  TuNSTALL  Taylob,  A.B.,  M.D.,  Profe-ssor  of  Orthopedic  Surgery. 

CoMPTON  RiELY,  M.D.,  CMcf  of  Clinic. 

W.  H.  Daniels,  M.D.  H.  L.  Wheeler,  M.D. 

W.  H.  Darby,  M.D. 

Gewito-Urinnry. 
A.  J.  Underbill.  M.D..  Chief  of  Clinic. 
W.  H.  CouNciLL,  M.D.  W.  H.  Toulson.  M.D. 

'Neurology. 

Irving  J.  Speab,  M.D..  Professor  •/  yeurologi/. 

G.  M.  Settle,  M.D..  Chief  of  Clinic. 

J.  A.  Skladowsky.  M.D.  B.  Pushkin,  M.D. 

Proctology. 

G.  Milton  Linthicum,  A.B.,  M.D..  Professor  of  Proctology. 

J.  D.  Reeuer.  M.D..  Chief  of  Clime. 

Tuberculosis. 

J.  E.  O'Neill.  M.D.,  Consultant. 

C.  C.  Habliston,  M.D..  Cfiief  of  Clinic. 

X-Ray. 

Harry  J.  W-alton,  M.D.,  Roentgenologist. 

Miss  Sue  W.  Shbiver,  Technician. 

Social  Service. 
Miss  Mary  Glackin.  Directress. 


MERCY  HOSPITAL  STAFF. 

SURGICAL  DIVISION. 

Surgeons. 
Archibald  C.  Harbison.  M.D.  Alexius  McGlannan.  M.D. 

W.  D.  Wise.  M.D.  C.  F.  Blake,  M.D. 


14  :\IK1J(Y    HOSPITAL    STAFF. 

Ass()(i(it(  Siirtjrijits, 
Elliott  H.  Hutchixs.  M.D.  Hakvey  B.  Stonk.  M.]  t. 

R.  H.  LocHKR.  M.I».  A.  M.  Evans.  M.]>. 

Thomas  K.  Chawbkbs,  M.l  >.  WH-i.iam   W.  Kkqiardt.  M.D. 

F.    L.   .iKNNl.MiS.   M.I). 

Af<xistiiiit   Sur!jroii.s: 
Amos  Hutchiks,  M.D.  F.  X.  Kkakm.v.  M.1>. 

I.  O.  RincELY,  M.D.  ().  S.  I.LOvu.  M.D. 

EVERARD    RRlStOE.    M.D. 

Ol)hthahnoh}fiist  ami  Otnloijist. 
Harky  Friedexwald.  M.D. 

A.ssociatr.s. 
H.  K.  Fleck.  M.D.  .J.  W.  Downey.  M.D. 

Rhinol Off i fits  (tiiil  Larjiiiffoloffisis. 
Frank  D.  .Sanger.  M.D.  Georde  W.  Mitchell,  M.D. 

Assistant^. 
W.  F.  Zinn,  M.D.  Raymond  McKexzie.  M.D. 

Proctologi'<t. 
Charles  F.  Blake.  M.D. 

Assistoiit. 
L.  J.  Rosenthal.  M.D. 

Orthoijfdir  SKrffroii. 
.\lbertus  Cotton.  M.D. 

A-ssoctatr. 
H.  E.  Rogers.  M.D. 

Urologist. 
A.  G.  Rytixa,  M.D. 

Assistant. 
A.  J.  GiLLLS.  M.D. 


ME1>ICAL   DIVISION. 
J'hiisiciaiis. 

WlLLL\M    E.    Eo«K\VOOD.    M.D.  ("AKV    K.    (iAWKLE.    M.D 

Standish  McCleary,  M.D.  H.  (J.  Keck.  M.D. 


MEKCY   HOSPITAL   STAFF.  lo 

Associafesi. 
HUBEKT  C.  KiSAFP,  M.D.  E.  E.  Mavek.  M.D. 

C.  (  .  W.  JuDD.  M.I).  Bartus  p.  Baggott.  M.D. 

Assistants. 

Martin  F.  Sloan.  M.I).  G.  D.  McLean,  M.D. 

J.  W.  Martindale,  M.D. 

GastrD-EntcrolOf/ists. 
JuLit's  Friedenwald.  M.I). 

Associates. 
T.  Freherick  Leitz.  M.D.  Theodore  Morrison,  M.D. 

Assistants. 
Maurice  Fei.dman.  M.D.  Joseph  Sindler,  M.D. 

Peiliatrist. 
John  Ruhrah.  M.D. 

Associate. 
KiKiAi;  B.  Friedenwald,  M.D. 

.\(Hiol<tf/ist  ami  I'si/chiatrist. 
Andrew  ('.  (iillis.  M.D. 

Assistaiit'<. 
L.  A.  M.  Krause.  M.D.  Milford  Levy,  M.D. 

Deninitolof/ist. 
Melvin  Rosenthal.  M.D. 


OBSTETRICAL  DIVISION. 

Obstetricians. 
Geo.  W.  Dobbin.  M.D.  .     Charles  K.  Brack.  M.D 

Associate  OJistdiiciaiis. 
E.  v.  Smith.  M.D.  T.  K.  Galvin.  M.D. 


GYNECOLOGICAL  DIVISION. 

(Itinecolof/ists. 
V^uliam  S.  Gardner,  M.D  Abraham  Samuels,  M.D. 


16  MEKCY  HOSPITAL  DISPENSARY  STAPF      ' 

Associate  Gynecologists. 

T.  K.  Galvin,  M.D.  E.  p.  Smith,  M.D. 

George  Stbaiss.  M.D. 


PATHOLOGICAL  DIVISION. 

Pathologists. 
Standish  McCleary,  M.D.  Hugh  R.  Spen'ceb,  M.D. 

Clinical  Pathologist. 

H.   T.   COLLENBEBG.   M.D. 

Technician — Sister  M.  Joan,  Ph.G. 


DEPARTMENT  OTO-NEIROLOGY. 
J.  W.  Downey,  Jr.,  M.D. 


X-RAY  DEPARTMENT. 

Radiographers, 
Albertus  Cotton,  M.D.  Harby  L.  Rogers,  M.D. 

MERCY  HOSPITAL— RESIDENT  STAFF. 

J.  J.  Ibwin.  Chief  Resident. 

C.  F.  Foley,  M.D.  K.  W.  Golley.  M.D. 

F.  A.  RiES,  M.D.  J.  S.  Grabill,  M.D. 

F.  H.  Pacienzo,  M.D.  C.  E.  Hawks,  M.D. 

J.  B.  Ryon,  M.D.  H.  V.  Uffelman,  M.D. 

J.  E.  Koplowitz,  M.D.  Oscar  G.  Costa,  M.D. 


DISPENSARY  STAFF  OF  MERCT  HOSPITAL. 

Surgenj. 

Supervisors. 
Alexius  McGlannan,  M.D.  W.  D.  Wise,  M.D. 

Attending  Surgeons. 
A.  M.  Evans,  M.D.  O.  H.  Lloyd.  M.D. 

D.  S.  Mohr,  M.D.  Clyde  Marvel,  M.D. 

F.  L.  Jennings,  M.D.  A.  F.  Hutchins.  M.D. 

F.  X.  Kearney,  M.D.  Everard  Briscoe,  M.D. 


MEECY  HOSPITAL  DISPENSARY  STAFF 

Genito  Uiiiiorii  Siinjerii. 
Supervisor.  A.  G.  Rytina,  M.D. 


A.    L.   TUMBLESON,    M.D. 

Harris  Goldman,  M.D. 


Attend inp  Surgeons. 

J.  F.  HOGAX.  M.D. 
Orthopedic  Surgeru. 


H.  C.  KXAPP.  M.D. 
A.  J.  Gir-Lis.  M.D. 


ALUEBirS  COTTOX.  M.E>. 


Harry  L.  Rogers.  M.D, 


Medicine. 
Supervisor,  Wm.  F.  T.ockwood. 


Martin  F.  .Sloan.  M.D. 


Attendimj  Physicians 


J.  W.  Martindalk.  M.D. 


B.  T.  Baggott.  M.D. 


Diseases  of  Stomach. 
Supervisor.  Jllius  Friedenwald.  M.D. 


T.  Frederick  Leitz,  M.D. 
Theodore  Morrison,  M.D. 


L.  A.  M.  Krause,  M.D. 


W.  S.  Gardner,  M.D. 


E.  V.  Smith.  M.D. 
T.  K.  Galvin.  M.D. 


W.  F.  Zinn.  M.D. 


Attending  Phiisicians. 

Xervous  Diseases. 
Supervisor,  A.  C.  Gillis 

Attending  Physicians. 

Wm.  J.  Todd.  M.D. 

Diseases  of  Women. 
Supervisors. 

Attending  Surgeons. 


M.  Feldman.  M.D. 
Joseph  Sindler.  M.D. 


Milford  Levy.  M.D. 


A.  Samuels,  M.D. 


H.  Palmisiano.  M.D. 
C.  F.  J.  Cot-GHLiN.  M.r». 


Diseases  of  \iiftp  and  Throat. 


R.  F.  McKenzee.  M.D. 


Diseases  nf  Ei/f  and  Ear. 
H.  K.  Fleck.  M.r».  Joseph  Kemler,  M.D. 

J.  W.  DowxEY.  Jr..  M.D.  M.  Raskin.  M.L*. 


KERXA>'    HOSPTTAI,   STAFF 

y(  in<)-()toli>(/!/. 
J.  W.  DowxEY.  Jr..  M.D. 

I'roctologji. 
L.  J.  Rosenthal.  M.D. 

D<r>iiutolo(j!i. 
Melvin  Rosenthal.  M.D. 

i^ocial  Scrrirr  Department. 

Katherine  a.  Monahan,  R.X..  Director. 
Catherine  Campbell.  R.N.,  Assistant. 
Claba  E.  Connery,  R.X..  Vhirf  Dlspensarij  yurve 
Helen  M.  Moore,  Register. 


THE  JAMES  LAWRENCE  KER^A^  HOSPITAL  AAD  INDUSTRIAL 
SCHOOL  OF  MARYLAND  FOR  CRIPPLED  CHILDREN. 

R.  Tlnstall  Taylor.  A.B..  M.D..  ^<urgeon-in-Chief. 

A-tsoriate   S u rgro ns. 
Sydney'  M.  Conk.  A.R..  M.D.  Albertus  Cotton.  A.M..  M.D. 

COMPTON    RlELY.    ^M.D. 

Atteiiiliiu;  (Did  Di^innsan.i  Surgeons. 
W.  H.  Daniels.  M.D.  •  W.  Arthir  Darby.  M.D. 

I iistnirtors  in  Comctire  (iiininastics. 
Miss  Anita  Renshaw  Presstman.  Miss  Elizabeth   Emory 

Miss  Mary  H.  Lee.  J'rinciiml  of  School. 

Miss  .\nna  Ciianulee.  Kinil<  rgnrtncr  mid  I  iidiistrial  Icaeher. 

i\o<  nt(i<  no}ogii<tN. 
Henry  J.  Walton.  M.D.  J.  F.  Lurz.  M.D. 

• 
Attending  PUixtic  Surgion. 

John   Staige  Davis.  B.Sc.  M.D. 


KERXAX  HOSPITAL  STAFF  19 

Atttmlinfj  f'hiiNiciaii. 
Benjamin  Tappax.  K.A..  M.D. 

Attouiiiif/  Huvfieon. 
A.  M.   Shipley.  M.D. 

Attviiilinij  Larntif/olist. 
F.  B.  Andkrsox.  M.r>. 

Attend intj  Drnnatotof/ist. 
JoHx  R.  Abercrombu:.  A.B.,  M.I>. 

Attend iiifj  Patholof/i.st. 
Howard  J.  Maloeis.  M.I*. 

Attendin;/    [  roloffist. 

Gideon  Timberlakk.  M.D. 
\ 

Attending  (h-iili-<t  and  .{iirisl. 
William  Tahun.  M.I>. 

Attendin;/   \eiind(tf/i.-tf. 
Ihmxg  .J.  Speak.  M.I>. 

Attendin;/  Dentists. 
G.  K.  P.  Tkuitt.  D.D.S.  J.  B.  Bell.  D.D.S. 

<  'on-snltin;/   Snir/eons. 
W.  S.  Halstead.  A.B..  LL.D..  H.Sc  M.D.         .1.  M.  T.  Finney.  A.B..  M.D. 
Randolph  Winslow.  A.M..  M.r>..  I,I..D.  .Vrchibald  ('.  Harrison.  .M.D. 

Consult  in;/   I'hiisiciiins. 
Thomas  E.  Brown,   A.B..  M.I>.  Llewellys  F.  Barker,  A.B..  M.D. 

Thoma-s  B.  Fuixher.  A.B..  M.D.  William  S.  Thayer.  A.B..  M.D. 

Consiiltinf/  Oritli-st. 
Hiram   Wood.'^.  M.D. 

Consnltin;/  Ijiriinyoloist. 
John  X.  Mackenzie.   A.B..  M.D. 

Disjiensorii  and   S(jri(il  Seiviee  Xiirse. 
Miss  Mabel  Brown,  R.N. 


20  BAY  VIEW  HOSPITAL  STAFF 

STAFF  OF  THE  CITl  HOSPITAL  AT  BATTIEW. 

Thomas  R.  Boggs.  S.B..  M.D..  Physician-in-CMef. 

Abthuk  M.   Shipley,  M.D..  Surgeon-in-Chief. 

H.   D.   McCarty,   M.D..   Phj/sician-hi-Chief  to   the  Municipal   Tuberculosis 

Hospital. 
John  R.  Cash.  M.D.,  Pathologist. 


CONSULTING  STAFF. 

Ophthalmologist. 
James  J.  Mills,  M.D. 

Otologist. 
William  TABf  n.  M.D. 

Oytiecologist. 
R.  G.  WiLLSE,  M.D, 

Urologist. 
W.  H.  TorLSON,  M.D. 

Largynologist. 
Frank  Dyee  .Sanger,  M.D. 

Pediatrician. 
John  Ruhrah.  M.D. 

Neurologist. 
Henby  M.  Thomas.  M.D. 


ST.  ELIZABETH   HOME. 

Attending  Physicimis. 

Edgar  B.  Friedenwald,  M.D. 

Frank  Ayd,  M.D. 

Surgeon. 
Alexix^s  McGlannan.  M.D. 

yeurologist. 
A.  C.  GiLLis,  M.D. 


ST,  Vincent's  asylum  stafi*  21 

STAFF  OF  NURSERY  AN»  CHILD'S  HOSPITAL. 

Attending  Physicians. 
Edgar  B.  Fbiedenwald,  M.D.  Harry  Goldberg,  M.D. 

Consulting  Physicians  and  Surgeons. 

John  Ruhrah,  M.D.  Wm.  S.  Baee,  M.D.  Wm.  F.  Lockwood,  M.D. 

Ai^ERTUs  Cotton,  M.D. 

Oculist  and  Aurist. 
Harry  Fbiedenwald,  M.D. 

Superintendent. 
Mrs.  O.  V.  Jones. 


ST.  VINCENT'S  INFANT  ASYLUM. 

Visiting  Physicians. 
Charles  O'Donovan,  A.M.,  M.D.  J.  E.  Poulton,  M.D. 

Eugene  H.  Haywabd,  M.D.  J.  K.  B.  E.  Seegar,  M.D. 

F.  J.  Powers,  M.D. 

Visiting  Surgeon. 
Alexius  McGlannan,  M.D. 

Visiting  Oculists  and  Aurists. 
J.  Frank  Crouch,  M.D.  Clyde  E.  Clapp,  M.D. 

Visiting  Orthopedic  Surgeons. 
Sydney  M.  Cone,  A.M.,  M.D.  Compton  Reilly,  M.D. 

Visiting  Proctologist. 
G.  Milton  Linthicum,  A.M.,  M.D. 

Pathologist. 
Sydney  M.  Cone,  A.M.,  M.D. 


MATRICULATES,  UNIVERSITY  OF  MARY- 
LAND SCHOOL  OF  MEDICINE  AND  COLLEGE 
OF  PHYSICIANS  AND  SURGEONS. 
1920—1921. 


POST-GRADUATES   AND   SPECIAL  STUDENTS. 


Name  State 

Chapman,    Arthur    Wm New  York 

Feinstein,    Elliott Maryland 

Hunt,    Kose   B Maryland 

Lang,   Robert   Gibson West   Virginia 


Name  State 

Mayoral,    Joaquin Cuba 

Pritchard,    Ruth    S Bahama    Islands 

Wiener,  Joseph New-  York 


FOURTH  YEAR  CLASS. 


Name  State 

Aubrey,  John  Forsyth Maryland 

Badagliacca,   Francis  Lucian.  .  New   .Jersey 

Barnes,  Bruce New  Jersey 

Benson,   Carl  Fisher Maryland 

Bernardo,    John    Ralph Delaware 

Boniiglio,    Vincent Maryland 

Bose,   Jogesh  Chandra,   B.   S Maryland 

Broadrup,    Earl   Edgar Maryland 

Castro,   Andres  G Costa   Rica 

Costa,   Oscar  G Porto  Rico 

Culver,   Samuel  Hearn Delaware 

Dorf,  Herman  Jacob New  York 

Fisher,   C.   F West  Virginia 

Fisher,   Daniel   Sebastian Maryland 

Foley,    Charles    J Maryland 

Franklin,  Joseph  P.,   B.  A Alabama 

Freedom,    Leon Maryland 

Gardner,  Willetts  Walton,  A.  B..New   York 

GoUey,   Kyle  Wood Maryland 

Grabill,    J.    Stanley Maryland 

Guyton,  John  Willis Maryland 

Hawks,    Cyrus   Eugene Virginia 

Heitsch,   Hubert  Messner Michigan 

Kobgood,  Legan  Henry,  B.  S., 

Massachusetts 

Hoheb,   Albert   Salomon Porto  Rico 

Holofcener,    Julius    I Maryland 

Jaffe.    Albert Maryland 

John  Baxter,  S Virginia 

Joska,    Vincent    Vernon Maryland 

Joyner,    George   Richardson Virginia 

Keegan,  Daniel  Francis,  B.  A. .  Connecticut 

Kemp,    Richard    Joseph Maryland 

Lass,    Louis New    York 

Luban,    Benjamin New   York 

McCoy,  Arley  Von,  A.  B. .  .  .  West  Virginia 

Martinez,   Ezequiel Porto  Rico 

Matthews,   Stanley  Wm  ....  North  Caroln* 


Name  State 

Monniger,   Arthur    Cecil Pennsylvania 

O'Rourk,    Thomas    Rutter Maryland 

Pacienzo,    Frank    Anthony Maryland 

Paulson,     Moses Maryland 

Peters,  Edgar  Allan  Poe,  B.  S. .  .  Kentucky 

Pillsbury,    Harold    C Maryland 

Plyler,  Ralph  Johnson,  A.  B., 

North  Carolina 

Pokomy,     Joseph Maryland 

Quinones,    Norberto   A Porto  Rico 

Reynolds,    Francis   A ilassachusetts 

Ries,    Ferdinand   A Maryland 

Romilly,    Harold    A Virginia 

Ryon,   James  Barry,   A.  B Maryland 

Sabin,   Fred   C New   York 

Savage,    Philip    J Connecticut 

Schilling,    Jesmond    Wm Pennsylvania 

Seay,   Thomas  Waller Virginia 

Sherman,     Solomon Maryland 

Shircliff,  EUiott  Walter Maryland 

Shubert,    Felix    S Pennsylvania 

Skvarla,  John  Augustus New  Jersey- 
Sowers,  Jacob  Long,  B.   S.,  North  Carolina 

Stone,    Saul    Gordon Ohio 

Szczerbicki,    John    Valentine.  ...  Maryland 

Tilghman,    Stanley   J ilaryland 

Timko,    Louis    Michael Pennsylvania 

Wangler,   Herman  Ernest New  York 

Ward,   Edwin  E Maryland 

Weinkauf,     Ferdinand Michigan 

Wells,   George  Edward Maryland 

Wiest,   Paul  Foreman West   Virginia 

Wilkerson,    James    Herbert Maryland 

Williams,    Mortimer    H Virginia 

WUson,   W.   Wellford.   Phar.   D.,   Maryland 

Wolfe,  James  Clinton New  Jersey 

Yeager,  Leslie  Arno.   B.    S Marvland 


MATRICULATES    1920-1921 


23 


THIRD  YEAR  CLASS. 


Name  State 

Bailey,   Harry,   B.   A Connecticut 

Bolewicki,  Peter  Edward,  A.  B.,  Maryland 

Buchness,  Anthony  V.,  A.  B Maryland 

Champe,  Jr.,  Ira  Preston .  .  .  West  Virginia 

Doshey,  Louis  Jacob,  B.  A New  York 

Fleischmann,    Berthold,    B.    S. .  .  New   York 

Freidus,    Elias New    Y''ork 

Fritz,   Julius  Dudley New  York 

Fulton,   William   James Maryland 

Ginsberg   William,    B.   A New   Y''ork 

Goldmann,  Bernhard  Alexander, 

Pennsylvania 

Gollick,  William  A.,   B.  S New  Jersey 

Gordon,    Herbert New    York 

Greenbaum,   Leonard   Harry Maryland 

Groff,    Morris New   York 

Hatfield,   Daniel   S West  Virginia 

Halley    George    C Idaho 

Harman,  Robert  Dave,  B.  S .  .West  Virginia 
Hollister,  William,  B.  S..  .  .North  Carolina 
Horowitz,   Herman  Jack,  B.  S.,  New  Y^ork 

Huff,    William,    B.   A Virginia 

Ingram,   David  N Maryland 

Keefe,   George  G.,  A-  B Connecticut 

Kerdasha,    Geo New    Jersey 

Krager,  John  J.,  B.  A Maryland 

Kunkowski,  Andrew Maryland 

Lang,  Milton  Charles Maryland 

Lawson,  Lawrence  Wells,  B.  A., 

West  Virginia 


Name  State 

McCoy,  C.  Glen,  A.  B West  Virginia 

Mercier,  Albin  Scott,  A.  B Maryland 

Middlemiss,   Wm.   Robert,   B.   S Utah 

Morgan,  Edw.  Nicholas New  York 

O'Connor,  John  Andrew,  A.  B. .  .Maryland 

Noll,   Louis,   B.   S Connecticut 

Payiie,  John  Edward,  B.  S.,  West  Virginia 

Peters,   H.  Raymond,   B.  A Maryland 

Pittman,   Henry  Lee North   Carolina 

PuUen,    Guy  Foote Connecticut 

Rhodes,  Bricey  Milton Florida 

RndisiU,  John  David,   A.   B., 

North    Carolina 

Salzberg,    Abraham New    York 

Saporito,   Archibald  R New  Jersey 

Sekerak,  Arthur  Joseph  Francis, 

Connecticut 

Scotellaro,  Nicholas  J New  York 

Shannon,    George   Edmon Maryland 

Shapin,    Sydney New  Y'ork 

Shapiro,   Louis  Mendelsohn,   B.  A., 

Connecticut 

Sternberg,    Harry New   Y''ork 

Stovin,  Joseph  Samuel,  Ph.  B.,  Connecticut 

Stout,   Philip   David,   B.  A Tennessee 

Sweet,  Samuel  Waterman,  B.   S., 

New  York 

Trynin,    Aaron   H.,    B.   A New    York 

Warfield,  Jr.,  John  Ogle,  A.  B., 

Pennsylvania 


Linke,   Julian  P New   Jersey     Wilson,  Thomas  Norwood,  A.  B.,  Maryland 


Name  State 

Beck,   Nathaniel   M.,    A.    B Maryland 

Berkson,   Morris  I Pennsylvania 

Cortese,   Anthony   Edward ....  New  Jersey 

Dart,    Frederick    Bond Connecticut 

Desane,   Joseph New  York 

Edmonds,   John  Milton Michigan 

Evatt,  Clay  Wclbourn South  Carolina 

Feraca,   Salvadore  J New  York 

Gillum,    Donald    A Maryland 

Glass,  Benjamin  E New  Jersey 

Goldberg,    Ben New   York 

Gutowski.   Joseph  Matthew ...  New   Jersey 

Hagerman,    Paul West   Virginia 

Harp,    J.    Elmer Maryland 

Hirsch,    Philip New   Y''ork 

Hundley,  Jr.,  John  T.   T.,  A.  B. .  .  Virginia 

Keith,  Marion  Yates North  Carolina 

Kenney,  Joseph  R.,   A.   B. .  .  .  Pennsylvania 

Knipp,    George    S Maryland 

Kraut,  Arthur  Milton New  Jersey 

Ksrper,    Frederick Pennsylvania 

Long,  Ira  C,  A.  B North  Carolina 

Love,  Jr.,  Wil'iam  S.,  A.  B Maryland 

*Note — Not  in  attendance. 


SECOND  YEAR  CLASS. 

Name  State 

McLean,  Herbert,   B.  A New  Jersey 

McVay,  Edward  A.,  A.  B. .  .  .  Rhode  Island 
*Maurillo,  Dominick  Francis,  A.  B., 

New  York 
Newcomer,  David  Redenon,  B.  S., 

Maryland 

Parson,  Willard  Sigsbee Pennsylvania 

Peterman,    James   Elmer Pennsylvania 

Pontery,  Herbert New  Jersey 

Povalski,  Alexander  William..  New  Jersey 

*Rio,  del  Juan Porto  Rico 

Rothfuss,   Paul  A.,   B.   S Pennsylvania 

Ruche,    Harry   Charles Pennsylvania 

Schorr,   Richard New  York 

Shealy,  Walter  Hal,  B.  A..  .South  Carolina 
Smith,  Charles  Franklin  ....  Pennsylvania 
Steincrohn,    Peter    Joseph.  ..  .Connecticut 

Sussman,   Abram  Alles Maryland 

Touhey,   Thomas  Joseph Delaware 

Ware,    Jr.,    Harry    Hudnall Virginia 

Wasserstrom,    Sidney New    York 

Weinert,   Henry  V New  Jersey 

White,   Robert   Stanislaus ..  .West  Virginia 


24 


MATRICULATES    1920-1921 


FIEST   YEAE   CLASS. 


Name  State 

Allen,  Moore  Lowry Utah 

Anderson,   Albert  Louis Maryland 

Antonius,    Nicholas New   Jersey 

Austerlitz,  John,  Fhax.  D Maryland 

Barnes,    D.   Keith Utah 

Bartlett,   Jr.,   Charles  Wm Florida 

♦Battlstini,   Pedro  Arrache ....  Porto  Bico 

Bentz,   Felix Connecticut 

Bershatsky,   William New   York 

Bleier,    Louis New   York 

Boyd,    Kenneth   Bray Maryland 

Briglia,    Nicholas   Natale ....  Pennsylvania 

Carter,  Carl  John West  Virginia 

*Davila,  Jose  Estebau Porto  Rico 

Bdelman,   Edward  Isidor New  York 

Fisher,   Harry  Richard New  York 

Flax,   Ira  Isador New  Jersey 

Friedman,    Bernard New   York 

Friedman,    Irving New    Jersey 

Gattens,   Wilber  Elton Maryland 

Gottlieb,   Bernard  Norman New  York 

Granoff ,  Joseph  F New  York 

Greiflnger,  Marcus  Harry New  Jersey 

Grimm,   Wilson  O West   Virginia 

Grossblatt,   Philip New   Jersey 

Hamilton,   Dewey  Dallas .  .  .  West  Virginia 

Howell,   Clewell,  B.  S North  Carolina 

Jacobson,     Philip Maryland 

Kauffman,   Aaron  W Pennsylvania 

Koons,  Earle  Weant,  B.  S Maryland 

Knox,  Joseph  Clyde North  Carolina 

Kraczyk,  Michael  Joseph New  Jersey 

Blratz,    Fred    William Maryland 

Lailey,    Paul    Francis Pennsylvania 

Lehman,    Julius New   York 

Leibensperger,    George    F. .  .  .  Pennsylvania 

Levlne,    Samuel New   Jersey 

McLane,  William  Oliver,  B.  S. . .  Maryland 

Marciniak,    Edward   S New   Jersey 

Marsh,  James  T.,  A.  B Maryland 

*Note — Not    in    attendance. 


Name  State 

Marton,   Samuel New  York 

Maseritz,  Isidore Maryland 

Megahan,    Burke Pennsylvania 

Messinger,   Benjamin New  York 

Miller,  Benjamin Maryland 

Miller,    Jacob Maryland 

Miller,    Jose   G Maryland 

Molinsky,  Meyer New   York 

Moriarty,    Louis Connecticut 

Morris,    Philip New   York 

Morrison,   Jr.,   William   Henry, 

Pennsylvania 

*Muno2,  Justo  Luis Porto  Rico 

Nash,  A.  E New  Jersey 

Nelson,  James  Wharton,  A.  B. .  .  Maryland 

Neustaedter,    Theodore New   York 

Nocera,    Domingo Porto   Rico 

Norment,  John  E.,  A.  B Maryland 

Oyler,  Ralph  Ziegler,  B.  S. .  .  Pennsylvania 

Pachtman,    Isadora Pennsylvania 

Perry,  Arch.  H North  Carolina 

Pitkowsky,    Louis New    York 

♦Rodriguez,   VirgUio   Ortiz ....  Porto   Rico 

Sarubin,    Benjamin Maryland 

Scagnetti,   Albert New    York 

Scheindlinger,  Morris  I New  York 

Schlenger,   Leo  Brenner New  Jersey 

Schultz,  Louis  Ariel New  York 

Scimeca,   Antonio  Adolfo New   York 

Seliger,   Robert  V New  York 

Shapiro,  Ralph  N New  Jersey 

Tabershaw,   Arnold  Leon New  York 

Taub,    Samuel New   York 

Theuerkauf,    Frajik   Joseph.  .Pennsylvania 

Urbanski,  Adrian  Xavier New  Jersey 

Weiner,    Hymen   L. Pennsylvania 

Weinstock,   Alex.   A New   York 

Whaley,    Thomas   Bravard Maryland 

Woodyard,  Edwin  Sayre.  .  .  .  West  Virginia 
Zaslow,   John New  York 


GRADUATES   1920-1921  25 

GENERAL  SUMMARY  OF  STUDENTS  ATTENDING  THE  UNIVERSITY 
OF  MARYLAND,  SESSION  OF  1920-21. 

College  of  Home  Economics 21 

College  of  Agriculture 218 

College  of  Engineering 114 

'College  of  Liberal  Arts 76 

College  of  Education ^ 40 

The  School  of  Chemistry 30 

The  Graduate  School 23 

The  Summer  School.  1920 208 

The  Department  of  Militai-j-  Science  and  Tactics 194 

School  of  Medicine 252 

School  of  Law 474 

School  of  Dentistry 157 

School  of  Pharmacy 75 

Total 1,882 


GRADUATES,  UNIVERSITY   OF  MARYLAND   SCHOOL  OF  MEDICINE 

AND  COLLEGE  OF  PHYSICIANS  AND  SURGEONS, 

JUNE  1,  1921. 

Name                                                     State  Name                                                     State 

Aubrey,   Johii   Forsyth Maryland       John,    Baxter    S Virginia 

Badagliacca,  Francis  Luciaii..New  Jersey       Joska,    Vincent   Vernon Maryland 

Barnes,   Bruce New  Jersey       Joyner,    George    Richardson Virginia 

Benson,  Carl  Fisher Maryland  Keegan,   Daniel  Francis,   B.A. .  Connecticut 

Bernardo,    John   Ralph Delaware       Kemp,  Richard  Joseph Maryland 

Bonfiglio,    Vincent Maryland       Lass,    Louis New    York 

Bose,  Jogesh  Chandra,  B.  S Maryland       Luban,  Benjamin New  York 

Broadrup,   Earl   Edgar Maryland  McCoy,  Arley  Von,  A.  B. .  .  .West  Virginia 

Castro,  Andres  B Costa  Rica       Martinez,   Ezequiel Porto  Rico 

Costa,  Oscar  G Porto  Rico  Matthews,  Stanley  William.  North  Carolina 

Culver,    Samuel  Heam Delaware       O'Rourk,    Thomas   Rutter Maryland 

Dorf,  Herman  Jacob New  York       Pacienzo,    Frank   Anthony Maryland 

Fisher,  C.  F West  Virginia       Paulson,   Moses Maryland 

Fisher,   Daniel  Sebastian Maryland  Peters,  Edgar  Allan  Poe,  B.  S..  .Kentucky 

Foley,    Charles    J Maryland       Pillsbury,    Harold    C Maryland 

Franklin,  Joseph  P.,   B.  A Alabama  Plyler,  Ralph  Johnson,  A.  B., 

Freedom,    Leon Maryland  North  Carolina 

Gardner,  WUletts  Walton,  A.  B.  .New  York       Pokomy,   Joseph Maryland 

GoUey,  Kyle  Wood Maryland       Qulnones,  Norberto  A Porto  Rico 

Grabill,    J.   Stanley Maryland       Reynolds,    Francis  A Massachusetts 

Guyton,  John  Willis Maryland       Ries,   Ferdinand  A Maryland 

Hawks,    Cyrus  Eugene Virginia       Romilly,   Harold   A Virginia 

Hobgood,   Legan  Henry.  ..  .Massachusetts       Ryon,  James  Barry,  A.  B Maryland 

Hoheb,  Albert  Salomon Porto  Rico       Sabln,   Fred  C New  York 

Holofcener,    Julius   I Maryland       Savage,    Philip    J Connecticut 

Jaffe,    Albert Maryland       Schilling,   Jesmond    Wm Pennsylvania 


26 


PRIZEMEN 


Name  State 

Seay,  Thomas  Waller Virginia 

Sherman,    Solomon. Maryland 

Shircliff,  Elliott  Walter Maryland 

Shubert,   Felix    S Pennsylvania 

Skvarla,  John  Augustus New  Jersey 

Sowers,  Jacob  Long,  B.  S.,  North  Carolina 

Stone,    S.    Gordon Ohio 

Szczerbicki,    John   Valentine ....  Maryland 

Tilghmaii,    Stanley  J Maryland 

Timko,    Louis  Michael Pennsylvania 


Name  State 

Waugler,  Herman  Ernest New  York 

Ward,  Edvdn  E Maryland 

Weinkauf,    Wm.    Ferdinand. Michigan 

Wells,   George  Edward Maryland 

Wiest,    Paul   Foreman West   Virginia 

Wilkerson,    James    Herbert Maryland 

Williams,    Mortimer    H Virginia 

WUson,  W.  Wellf ord,  Phar.  D. . .  Maryland 

Wolfe,  James  Clinton New  Jersey 

Yaeger,  Leslie  Amo,  B.  S Maryland 


PRIZEMEN. 


T'uiversity  Prize — Gold  Medal Oscar  G.  Costa 

Certificate  of  Honor James  Heebert  Wilkerson 

Certificate  of  Honor Charles  Frederick  Fishfb 

Certificate  of  Honor Ferdinand  A.  Ries 

Certificate  of  Honor John  Ralph  Bernardo 

Certificate  of  Honor Jogesh  Chandra  Bose 

Clinical  Medicine  Prize Charles  F.  Fisher 

In  the  tliird  year  tlie  Jose  L.  Hirscti  prize  of  $50.00  was  awarded  to 
John  Ogle  Warfield,  Jr..  for  the  hest  work  in  Pathologj'  during  the  second 
and  tliird  years. 


THE  UNIVERSITY  OF  MARYLAND 
SCHOOL  OF  MEDICINE 

AND 

COLLEGE  OF  PHYSICIANS  AND 
SURGEONS. 

As  a  result  of  the  merger  accomplished  in  1915  the  combined 
schools  offer  the  student  the  abundant  resources  of  both  institu- 
tions, and,  in  addition,  by  earlier  combination  with  the  Balti- 
more Medical  College,  the  entire  equipment  of  three  large  medical 
colleges. 

The  School  of  Medicine  of  the  University  of  Maryland  is  one  of 
The  oldest  foundations  for  medical  education  in  America,  rank- 
ing fifth  in  point  of  age  among  the  medical  colleges  of  the  United 
States.  It  was  chartered  in  1807.  under  the  name  of  the  College 
of  Medicine  of  Maryland,  and  its  first  class  was  graduated  in 
1810.  In  1812  the  College  was  empowered  by  the  Legislature 
to  annex  three  other  colleges  or  faculties,  of  Divinity,  of  Law,  and 
of  Arts  and  Sciences,  and  the  four  colleges  thus  united  were  "con- 
stituted an  University  by  the  name  and  under  the  title  of  the 
University  of  Maryland." 

Established  thus  for  more  than  a  century,  the  School  of  Medi- 
cine of  the  University  of  Maryland  has  always  been  a  leading 
medical  college  ,  especially  prominent  in  the  South  and  widely 
known  and  highly  honored  throughout  the  country. 

The  beautiful  college  building  at  Lombard  and  Greene  Streets, 
erected  in  1814-1815,  is  the  oldest  structure  in  America  devoted 
to  medical  teaching.  Here  was  founded  one  of  the  first  medical 
libraries  and  the  first  medical  college  library  in  the  United 
States. 

Here  for  the  first  time  in  America  dissecting  was  made  a  com- 
pulsory part  of  the  curriculum ;  here  instruction  in  Dentistry  was 
first  given  (1837),  and  here  were  first  installed  independent 
chairs  for  the  teaching  of  Diseases  of  Women  and  Children  (1807) 
and  of  Eye  and  Ear  Diseases  (1873). 

The  School  of  Medicine  w^as  one  of  the  first  to  provide  for 
adequate  clinical  instruction  by  the  erection  in  1823  of  its  own 
hospital,  and  in  this  hospital  intramural  residency  for  the  senior 
student  was  first  established. 


28  CLINICAL    FACILITIES 

In  1913  Juncture  was  brought  about  with  the  Baltimore  Medi- 
cal College,  an  institution  of  32  years*  growth.  By  this  associa- 
tion the  facilities  of  the  Bchool  of  Medicine  were  enlarged  in  fac- 
ulty, equipment  and  hospital  connection. 

The  College  of  Physicians  and  Surgeons  was  incorporated  under 
the  Legislative  enactment  in  1872,  and  established  on  Hanover 
Street  in  a  building  afterwards  known  as  the  Maternite.  the  first 
obstetrical  hospital  in  Maryland.  In  1878  union  was  effected 
with  the  Washington  University  School  of  Medicine,  in  existence 
since  1827,  and  the  College  was  removed  to  its  present  location 
at  Calvert  and  Saratoga  Streets.  By  this  arrangement,  medical 
control  of  the  City  Hospital,  now  the  Mercy  Hospital,  was  ob- 
tained, and  on  this  foundation  in  1899  the  present  admirable 
college  building  was  erected. 


CLINICAL  FACILITIES. 

HOSPITALS  AND  DISPENSARIES. 
UNIVERSITY  HOSPITAL. 

The  University  Hospital,  which  is  the  property  of  the  Faculty 
of  Physic  of  the  University  of  Maryland,  is  the  oldest  institution 
for  the  care  of  the  sick  in  the  State  of  Maryland.  It  was  opened 
in  September,  1823,  under  the  name  of  the  Baltimore  Infirmary, 
and  at  that  time  consisted  of  but  four  wards,  one  of  which  was 
reserved  for  eye  cases.  By  successive  additions  this  hospital  was 
increased  to  more  than  fourfold  its  original  accommodations, 
there  being  added  to  it  a  large  clinical  amphitheatre,  a  students' 
building  for  the  accommodation  of  the  thirty  clinical  assistants, 
and  a  nurses'  building  for  the  accommodation  of  the  pupils  of 
the  Training  School  for  Nurses.  The  yearly  increase  in  the  num- 
ber of  patients  seeking  admission  to  the  hospital,  however,  more 
than  kept  pace  with  the  increase  in  accommodations,  and  the 
Faculty  therefore  erected  an  entirely  new  and  modern  hospital 
of  fully  double  the  capacity  of  the  former  building. 

The  University  Hospital  is  constructed  of  brick  and  Tennessee 
limestone  in  the  Colonial  style  of  architecture,  fronting  175  feet 
upon  Lombard  Street,  and  about  the  same  on  Greene  Street.  It 
is  sui)plied  with  the  most  modern  and  approved  system  of  heat- 


CLINICAL    FACILITIES  29 

ing,  ventilation,  etc.,  and  equipped  with  all  modern  requirements 
and  conveniences  for  the  care  of  the  sick,  and  for  the  clinical 
instruction  of  the  students  of  the  University. 

It  is  one  of  the  largest  and  finest  hospitals  owned  and  con- 
trolled by  any  medical  school  in  America,  and  in  point  of  archi- 
tectural beauty,  convenience  and  completeness  of  arrangements 
and  equipment  compares  favorably  with  other  hospitals. 

An  important  adjunct  to  the  hospital  is  the  postmortem  build- 
ing, which  is  constructed  with  special  reference  to  the  instruction 
of  students  in  pathological  anatomy. 

The  hospital  is  situated  opposite  the  University  building,  so 
that  the  student  loses  no  time  in  passing  from  the  lecture  halls 
to  the  clinical  amphitheatre,  dispensary  and  wards. 

A  portion  of  the  hospital  is  used  as  a  marine  hospital  for  for- 
eign seamen.  The  great  importance  of  Baltimore  as  a  shipping 
point  brings  into  her  harbor  many  vessels  from  all  parts  of  the 
world,  and  the  sick  sailors  who  are  cared  for  in  the  wards  of  the 
institution  give  the  students  an  opportunity  to  observe  a  large 
variety  of  diseases.  Another  considerable  portion  of  the  building 
is  used  as  a  Municipal  Hospital,  and  contains  charity  beds  sup- 
ported by  the  City  of  Baltimore.  This  department  of  the  hospital 
is  taxed  to  its  utmost  capacity  to  afford  accommodations  for  the 
patients  seeking  admission. 

Owing  to  its  location,  being  the  nearest  hospital  to  the  largest 
manufacturing  district  of  the  city,  the  University  Hospital  re- 
ceives for  treatment  a  very  large  number  of  accident  cases  of  all 
kinds,  both  slight  and  serious.  These  cases,  as  well  as  patients 
suffering  from  the  various  diseases  of  our  own  climate,  occupy 
the  beds,  and  add  greatly  to^  the  facilities  of  clinical  teaching 
enjoyed  by  the  school.  The  facilities  for  clinical  instruction  have 
been  greatly  enlarged  by  an  appropriation  by  the  State  of  Mary- 
land for  the  support  of  free  beds  for  patients  from  the  various 
counties. 

MERCY  HOSPITAL. 

The  Sisters  of  Mercy  first  assumed  charge  of  the  Hospital  at  the 
corner  of  Calvert  and  Saratoga  streets,  then  owned  by  the  Wash- 
ington University,  in  1875.  By  the  merger  of  1878  the  Hospital 
came  under  the  control  of  the  College  of  Physicians  and  Surgeons, 
but  the  Sisters  continued  their  work  of  administering  to  the 
patients. 

In  a  very  few  years  it  became  apparent  that  the  City  Hospital, 
as  it  was  then  called,  was  much  too  small  to  accommodate  the 


30  CLINICAL    FACILITIES 

rapidly  growing  demands  upon  it.  However,  it  was  not  until 
1888  that  the  Sisters  of  Mercy,  with  the  assistance  of  the  Faculty 
of  the  College  of  Physicians  and  Surgeons,  were  able  to  lay  the 
cornerstone  of  the  present  Hospital.  This  building  was  completed 
and  occupied  late  iu  1880.  Since  then  the  growing  demands  for 
more  space  has  compelled  the  erection  of  additions,  until  now 
there  are  accommodations  for  351  patients. 

In  1909  the  name  w^as  changed  from  The  Baltimore  City  Hos- 
pital to  Mercy  Hospital. 

Mercy  Hospital  is  located  in  the  center  of  a  city  of  750,000 
inhabitants,  and  is  under  the  exclusive  medical  control  of  the 
College  of  Physicians  and  Surgeons.  It  adjoins  the  College  build- 
ing, and  all  surgical  patients  from  the  public  wards  are  operated 
upon  in  the  College  operating  rooms.  This  union  of  the  Hospital 
and  College  buildings  greatly  facilitate  the  clinical  teaching,  as 
there  is  no  time  lost  in  passing  from  one  to  the  other. 

Mercy  Hospital  is  the  hospital  of  the  United  Kailways  and 
Electric  Company  of  Baltimore  City,  and  receives  patients  from 
the  Baltimore  &  Ohio  Eailroad  Company  and  from  the  Pennsyl- 
vania Kailroad  Company  and  its  branches. 

During  the  calendar  year  of  1920  there  were  treated  in  the 
various  departments  of  this  hospital  more  than  20,000  people. 

FKANKLIN  SQUARE  HOSPITAL. 

The  Franklin  Square  Hospital  has  a  capacity  of  112  beds.  Dur- 
ing the  year  ending  December  31.  1920,  1,505  cases  were  treated 
in  the  hospital,  and  1,280  patients  were  treated  in  the  dispensary. 
Ten  hundred  and  thirty-nine  surgical  operations  were  performed 
in  the  hospital.  . 

LYING-IN  HOSPITALS. 
MATERNITY  HOSPITAL   OF   THE   UNIVERSITY  OF  MARYLAND. 

This  institution  is  also  the  pro]>erty  of  the  Faculty  of  Physic 
and  under  its  exclusive  control  and  direction,  and  is  conducted 
with  the  special  purpose  of  furnishing  actual  obstetrical  experi- 
ence to  each  member  of  the  graduating  class. 

New  accommodations  have  been  provided  in  the  general  hospi- 
tal, and  the  Maternity  Department  now  offers  better  facilities 
than  ever  before,  while  the  large  increase  in  clinical  material  has 
made  it  possible  to  offer  excellent  opportunities  for  post-graduate 
work. 


CLINICAL    FACILITIES  31 

THE  WEST  END  MATERNITY. 

The  West  End  Maternity  adjoins  the  Franklin  Square  Hospital 
and  furnishes  an  abundance  of  clinical  material,  which  is  under 
the  control  of  the  Faculty  of  Physic. 

OUT-PATIENT  CLINIC  AND  DISPENSARY. 

In  connection  with  the  University  Hospital  an  out-door  obstet- 
rical clinic  is  conducted,  in  which  every  case  has  careful  prenatal 
supervision,  is  attended  during  labor  by  a  graduate  physician  and 
graduate  nurse — one  senior  student  also  being  present — and  is 
visited  during  the  puerperium  by  the  attending  student  and  grad- 
uate nurse.  Careful  prenatal,  labor  and  puerperal  records  are 
kept,  making  this  work  of  extreme  value  to  the  medical  student, 
not  only  from  the  obstetrical  standpoint,  but  in  making  him  ap- 
preciate the  value  of  social  service  and  public  health  work. 

NUMBER  OF  PATIENTS. 

During  the  year  ending  December  31,  1920,  the  number  of  pa- 
tients treated  in  the  Lying-in  hospitals  connected  with  the  School 
was  as  follows : 

Number  of  Confinements  in  Hospitals 348 

Number  of  Confinements  Out-Patient  Department 904 

Average  number  of  cases  seen  by  each  student  of  the  graduating  class    18 

THE  MUNICIPAL  HOSPITALS— BAY  VIEW. 

The  clinical  advantages  of  the  University  have  been  largely  in- 
creased by  the  liberal  decision  of  the  Board  of  Supervisors  of  City 
Charities  to  allow  the  immense  material  of  these  hospitals  to  be 
used  for  the  purpose  of  medical  education.  There  are  daily  visits 
and  clinics  in  medicine  and  surgery  by  the  Staff  of  the  hospitals. 
The  autopsy  material  is  unsurpassed  in  this  country  in  amount, 
thoroughness  in  study,  and  the  use  made  of  it  in  medical  teach- 
ing. 

The  Municipal  Hospitals  consist  of  the  following  separate  hos 
pitals : 

The  General  Hospital,  160  beds. 

The  Hospital  for  Chronic  Cases,  8S  beds. 

The  Municipal  Hospital  for  Tuberculosis,  190  beds. 

City  Detention  Hospital  for  Insane,  450  beds. 


32  CLIXICAL    FACILITIKS 

THE  JAMES  LAWRENCE  KERNAN  HOSPITAL  AND  INDUSTRIAL 
SCHOOL  OF  MARYLAND  FOR  CRIPPLED  CHILDREN. 

This  institurion  contaiiih^  seveuty-iive  beds  for  the  active  treat- 
ment of  deformities.  It  is  situated  at  "Radnor  Park,"  a  colonial 
estate  of  seventy-five  acres  at  Hillsdale,  within  the  western  city 
limits,  reached  by  trolley. 

This  institution  has  city,  state,  endowed  and  private  beds  and 
every  modern  facility  for  the  treatment  of  orthopedic  cases  as 
well  as  a  most  beautiful  park-like  environment  and  farm,  and  is 
closely  afiBliated  with  the  University  of  Maryland,  for  bed-side 
instruction. 

ST.  TINCENrS  INFANT  ASYLUM. 

The  facilitiess  of  this  institution,  containing  250  infants  and 
children,  have  been  kindly  extended  to  the  University  of  Maryland 
by  the  Sisters  of  Charity.  This  large  clinic  enables  this  school  to 
present  to  its  students  liberal  opportunities  for  the  study  of  dis- 
eases of  infants  and  children. 


INSTITUTIONS     FOR    THE     TREATMENT     OF     THE     INSANE     AND 

FEEBLE-MINDED. 

The  SHEPrARD  and  Enoch  Pratt  Hospital  for  the  Insane. 
This  institution  is  one  of  the  most  modern  hospitals  for  the  treat- 
ment and  care  of  the  insane  in  this  country.  It  is  well  endowed 
and  its  superintendent  is  R.  M.  Chapman,  M.D.,  Clinical  Pl'ofes- 
sor  of  Psychiatry  at  the  University  of  Maryland.  In  this  hospital 
intensive  treatment  and  study  of  mental  diseases  is  carried  on,  a 
large  number  of  the  patients  entering  voluntarily.  The  students 
under  the  direction  of  Dr.  Chapman  and  his  assistants  in  a  series 
of  clinics  are  shown  the  early  manifestations  and  the  various 
stages  of  mental  diseases,  the  methods  of  treatment,  and  their 
effects. 

Mount  Hope  Retreat  for  the  Insane.  This  hospital  contains 
an  average  of  750  patients  and  is  attended  by  Dr.  Chas.  (t.  Hill, 
Professor  of  Psychiatn'  of  this  faculty.  Under  the  direction  of 
Dr.  Hill  and  his  assistants  the  students  are  given  opportunity  for 
the  study  of  large  groups  of  patients  showing  all  phases  of  vari- 
ous mental  and  nervous  disorders. 


UlSPEXSAEIES  33 

DISPENSARIES. 

The  dispensaries  associated  with  the  University' Hospital  and 
the  Mere}'  Hospital  are  organized  upon  a  uniform  plan  in  order 
that  the  teaching  may  be  the  same  in  each.  Each  dispensary  has 
the  following  departments:  Medicine,  Surgery.  Children,  Eye 
and  Ear,  Genito-Urinary,  Gynecology,  Gastro-Enterology,  Neurol- 
ogy, Orthopedics,  Proctology,  Dermatology,  Throat  and  Nose,  and 
Tuberculosis. 

All  students  in  their  junior  year  work  in  the  departments  of 
Medicine  and  Surgery  each  day  in  one  of  the  dispensaries. 

All  students  in  their  senior  year  work  in  the  special  depart 
ments  one  hour  each  day. 

Some  idea  of  the  value  of  these  dispensaries  for  clinical  teach- 
ing is  shown  by  the  number  of  patients  treated.  For  the  year 
1920  about  sixty-seven  thousand  visits  were  made  to  the  dispen- 
saries. 

In  addition  to  these  the  Dental  Department,  situated  upon  the 
grounds  of  the  L'niversity,  conducts  a  daily  clinic  which  is  open 
to  medical  students. 


University  Hospital  Dispensary  Report.  January  1.  to  December  31.  1920. 
J.  A.  Skladoaski.  M.D.,  Dispensary  Physician. 

■Department.  yew  Cases. 

Skin    2,561 

Children    1,318 

Obstetrical    1,285 

Surgical    841 

Eye  and  Ear 1,014 

Gynecology     598 

Medical 725 

Genito-Uriuary     557 

Neurology 126 

Orthopedics    92 

Gastro-Enterology    103 

Nose  and  Throat 3-53 

Tuberculosis    122 

Proctology    32 

9,727  25.007         34.734 


0?rf  Cases. 

Total. 

4,412 

6,973 

4,219 

5,537 

2,811 

4.096 

3,247 

4,088 

1.575 

2.589 

i,6as 

2,236 

1,502 

2,227 

1,480 

2.037 

1,682 

1.S08 

1,067 

1,159 

713 

816 

442 

795 

171 

293 

4S 

80 

New. 

Total. 

933 

3.300 

S46 

1,473 

416 

1,121 

418 

858 

556 

1,258 

221 

681 

31 

64 

262 

893 

40 

68 

46 

71 

85 

213 

219 

441 

1.734 

21,927 

34  LABORATORIES 

Mercy  Hospital  Dlsiiensurii  Nciiort.  .January  1  to  December  31,  1920. 
B.  S.  Hanna.  M.  D.,  Dispensary  Physician. 

Dispensary  Clinics.  Old. 

Surgical    2,367 

Medical    627 

Gynecological    , 705 

Eye  and  Ear 440- 

Nose  and  Throat 702 

Neurological 460 

Pediatric    33 

(Jastro-Intestinal    631 

Dental    28 

Proctological 25 

Orthopedic    128 

Dermatological    222 

Genito-Urinary   Surgery    20.193 

Total    26,561         5.807       32.368 


LABOKATOEIES. 

ANATOMICAL   LABORATOBIES. 

Tliese  laboratories  are  in  charge  of  the  Professor  of  Anatomy 
and  his  assistants.  The  University  has  recently  built  its  own 
storage  and  embalming  plant,  which  supplies  an  abundance  of 
anatomical  material.  Anatomical  material  is  furnished  in  abun- 
dance, free  of  charge. 

LABORATORY  OF  EXPERmENTAL  PHYSIOLOGY. 

This  laboratory  occupies  the  first  floor  of  Gray  Laboratory;  it 
includes  a  large  student  laboratory,  with  capacity  of  forty  stu- 
dents, a  room  completely  equipped  for  mammalian  experimenta- 
tion, a  stock-room,  and  an  office  for  the  professor  in  charge. 
Witliin  the  same  building  there  is  an  animal  room  in  which  there 
is  kc})t  a  constant  supply  of  material  for  experimentation  and 
demonstration.  The  laboratory  is  equipped  with  ample  appara- 
tus: there  is  a  complete  set  of  student  apparatus  available  for 
each  group  of  two  students,  wliile  the  special  apparatus  for  lab- 
oratory experimentation  and  class-room  demonstration  is  ade- 
quate for  the  needs  of  the  courses. 


laboiiatorip:s  t3o 

LABORATORY  OF  PHYSIOLOGICAL  CHEMISTRY. 

(See  page  52.) 

LABORATORY  OF   HISTOLOGY  AND   EMBRYOLOGY. 

This  laboratory  is  fully  equipped  for  teaching  Histology  and 
Embryology. 

There  is  a  large  collection  of  charts,  specimens  and  apparatus 
ii«ed  in  teaching.  The  necessary  equipment  for  the  practice  of 
technique  is  provided. 

LABORATORIES  OF  PATHOLOGY  AND  BACTERIOLOGY. 

The  subject  of  special  bacteriology  is  taught  during  a  portion  of 
the  second  year  in  a  well  equipped  laboratory  containing  steriliz- 
ers, water  baths,  and  other  necessary  equipment  for  this  purpose. 

The  subject  of  histopathology  is  also  taught  during  the  second 
year  in  a  properly  equipped  laboratory.  The  details  concerning 
this  work  are  described  under  the  subject  of  Department  of  Path- 
ology and  Bacteriology. 

The  instruction  in  gross  pathology  is  obtained  during  the  third 
year  by  attendance  upon  the  autopsies  at  the  University  Hospital 
and  the  Mercy  Hospital,  and  special  instruction  in  this  subject 
is  also  given  by  demonstrations  with  a  large  amount  of  pathologi- 
cal material  at  the  City  Hospitals  situated  at  Bay  View.  The 
subject  of  gross  pathology  is  also  taught  in  the  third  year  by 
means  of  lectures  and  demonstrations  to  sections  of  the  third 
year  class  and  a  special  effort  is  made  to  apply  this  subject  to  the 
explanation  of  the  symptoms  and  clinical  signs  of  disease.  The 
instruction  in  autopsy  technique  is  also  given  personally  to  small 
gi'oups  of  students. 

LABORATORIES  OF  CLINICAL  PATHOLOGY. 

These  laboratories  are  fully  e^uipi>ed  for  the  study  of  practical 
laboratory  work  in  its  relationship  to  clinical  medicine.  Each 
student  is  sui)plied  with  a  locker,  containing  sufficient  apparatus 
for  any  ordinary  examination. 

The  wards  and  out-patient  departments  of  the  hospitals  furnish 
an  abundance  of  material  for  study. 

By  reason  of  individual  e(iui]:nient.  much  work  outside  of  class 
hours  is  expected  of  the  student. 

The  class  rooms  are  adequately  lighted,  and  are  conveniently 
situated  for  teaching  purposes. 


36  AX:XUAL   APPOINTMENTS 

LIBRARIES. 

The  University  Library,  founded  in  1813  by  the  purchase  of  the 
collection  of  Dr.  John  Crawford,  now  contains  14,259  volumes,  a 
tile  of  58  current  journals,  and  several  thousand  pamphlets  and 
reprints.  During  the  year  ending  December  31,  1920,  141  volumes 
were  added.  It  is  well  stocked  with  recent  literature,  including 
books  and  periodicals  of  general  interest.  The  home  of  the  Library 
is  Davidge  Hall,  a  comfortable  and  commodious  building  in  close 
proximity  to  the  class  rooms  and  the  laboratories  of  the  Medical 
Department.  The  Library  is  open  daily  during  the  year,  except 
in  August,  for  use  of  members  of  the  Faculty,  the  students,  and 
the  profession  generally. 

The  Library  of  the  Medical  and  Chirurgical  Faculty  of  Mary- 
land, containing  many  thousands  of  volumes,  is  open  to  the  stu- 
dents of  the  school.  The  leading  medical  publications  of  the 
world  are  received  by  the  library  and  complete  sets  of  many  jour- 
nals are  available.  Other  libraries  of  Baltimore  are  the  Peabody 
(181,000  volumes)  and  the  Enoch  Pratt  Free  Library  (355,817 
volumes). 

All  these  libraries  are  open  to  the  students  of  the  school  with- 
out charge. 

The  proximity  of  Washington  places  the  immense  libraries  of 
the  national  capital  at  the  disposal  of  the  students  of  the  school. 


ANNUAL  APPOINTMENTS. 

On  February  first  of  each  session  the  following  annual  appoint- 
ments are  made  from  among  the  graduates  of  the  school : 

TO   THE   LTMVERSITY    HOSPITAL 

Medical  Superintendent.  , 

Five  Senior  Residents,  viz : 

Two  Resident  Surgeons. 

One  Resident  Physician. 

One  Resident  Gynecologist  and  Obstetrician. 

One  Resident  Pattiologist. 
Thirteen  Junior  Residents  on  a  rotating  service. 

A  number  of  students  are  appointed  each  year.  at. the  close  of 
tlie  session,  as  Clinical  Assistants  in  the  University  Hospital  for 
the  summer  months. 


REQUIREMENTS  FOR  MATRICULATION  ST 

TO  THE   MEBCY   HOSPITAL. 

Chief  Resident  Physician. 
Six  Resident  Surgeons. 
Four  Resident  Physicians. 
One  Resident  Gynecologist. 
One  Resident  Obstetrician. 

TO   THE   MARYLAND   GENERAL   HOSPITAL. 

Medical  Superintendent: 
Four  Senior  Residents,  viz : 

One  Resident  Surgeon. 

One  Resident  Physician. 

One  Resident  Gynecologist. 

One  Resident  Obstetrician. 
Eight  Junior  Residents  on  a  rotating  service. 

Each  resident  serves  a  term  in  every  department,  including  the 
pathological  laboratory  and  the  Maryland  Lying-in-Hospital. 

Many  appointments  to  other  hospitals  of  Baltimore  are  made 
annually,  to  which  graduates  of  this  school  are  eligible. 

REQUIREMENTS  FOR  MATRICULATION. 

Admission  to  the  course  in  medicine  is  by  a  completed  Medical 
Student  Certificate  issued  by  the  State  Department  of  Education 
of  Maryland.  This  certificate  is  obtained  from  the  Department  of 
Education  on  the  basis  of  satisfactory  credentials,  or  by  examina- 
tion and  credentials,  and  is  essential  for  admission  to  any  class. 

The  requirements  for  the  issuance  of  the  Medical  Student  Cer- 
tificate are: 

(ai  The  completion  of  a  standard  four-year  high  school  course 
or  the  equivalent,  and  in  addition, 

(bi  Two  years  or  sixty  semester  hours  of  college  credits,  in- 
cluding chemistry,  biology,  physics,  and  English. 

Women  are  admitted  to  the  Medical  Department  of  this  Uni- 
versity. 

(A)     DETAILS  OF  THE  HIGH  SCHOOL  REQUIREMENT. 

1.  Graduation  from  an  accredited  high  school  after  pursuing  a 
four-year  course  based  upon  an  eight-year  elementary  course  or 
its  full  equivalent ;  or 

2.  Successfully  passing  entrance  examinations  in  the  following 
subjects: 


38  KEQUIREMENTS  FOR  MATRICULATION 

(a)  Required  Eleven   (11)   Units. 

Units. 

English,  4  years 3 

Elementary  and  Intermediate  Algebra 1 

Plane  Geometry  (first  five  books) 1 

Two  j'ears  of  a  foreign  language 2 

Two  of  the  three  sciences — Biology,  Chemistry,  Physics 2 

American  History  and  Civics 1 

Ancient  History  or  English  History 1 

(h)   Elect  ires.  Four   (4)    Units. 

(1)  History  and  Political  Science: 

Ancient  History  or  English  History •. 1 

Mediaeval  and  Modern  History 1  or  1-2 

General  History    1  or  % 

Civics    Vl' 

Economics   Vo 

(2)  Language: 

French  2  years 2 

German  2  years 2 

Greek  2  years 2 

Hebrew  2  years 2 

Italian  2  years 2 

Latin  1  or  2  years lor  2 

Spanish  2  years 2 

(3)  Mathematics:  , 

Advanced  Arithmetic    Vo 

Advanced  Algebra 1 

Plane  Trigometry    y^ 

Solid  Geometry Vs 

(4)  Science : 

Physics.  Biology  or  Chemistry 1 

Physical  (Geography  and  Geology 1 

Astronomy    1,2 

Physiology  and  Hygiene V2 

(5)  Vocational  and  cultural  subjects: 

Agriculture    1 

Bookkeeping 1 

Commercial  Geography    , i,i 

Domestic  Science 1 

^    iilechanical  1  and  2 %  each 

Drawing  -^    Freehand  1  and  2 1/2  each 

Manual  Training   ■„. i 

Music 1 

Stenography 1  or  2 


EEQUIREMENTS  -FOB  MATRICULATION  39 

One  unit  in  any  subject  is  the  equivalent  of  work  in  that  subject  for  five 
periods  per  week  for  a  year  of  at  least  thirty-six  weeks,  periods  to  be  not 
less  than  forty-five  minutes  in  length.  One  unit  is  equivalent  to  2  semester 
credits  or  2  points. 

(B)     DETAILS  OF  THE  COLLEGE  REQUIREMENT. 

(/.  The  preliminary  college  course  shall  extend  through  two  col 
lege  sessions  of  at  least  thirty-two  weeks  each  of  actual  instruc- 
tion, including  final  examinations. 

6.  In  excellence  of  teaching  and  in  content,  the  work  of  this  pre- 
liminary college  course  shall  be  equal  to  the  work  done  in  the 
freshman  and  sophomore  years  in  standard  colleges  and  universi- 
ties. 

c.  This  preliminary  college  course  shall  include  courses  in  phy- 
sics, chemistry,  biology,  and  English,  each  course  to  embrace  at 
least  six,  eight  or  twelve  hours  of  work  in  each  subject,  as  shown 
in  the  schedule  following. 

SCHEDULE  OF  SUBJECTS  OF  THE  TWO-TEAR  PRE-MEDICAL 
COLLEGE  COURSE. 

Sixty  Semester  Hours  Required.  ^eme<iter 

Required  Courses  :  Hours. 

Chemistry    (a)    12 

Physics  (b)    , ■        8 

Biology    (c)    ; .         S 

English  Composition  and  Literature    (d) 6 

CouBSES  Steongly  Urged: 
A  modern  foreign  language. 
Comparative  vertebrate  anatomy 
Psychology 
Social  science 

A  semester  hour  is  the  credit  value  of  sixteen  weeks'  work  consisting  of 
one  lecture  or  recitation  period  per  week,  each  period  to  be  of  not  less  than 
fifty  minutes'  duration  net,  at  least  two  hours  of  laboratory  work  to  he 
considered  as  the  equivalent  of  one  lecture  or  recitation  period. 

(a)  Chemistry.  Twelve  semester  hours  required,  of  which  at 
least  eight  semester  hours  must  be  in  general  inorganic  chemistry, 
including  four  semester  hours  of  laboratory  work.  In  the  inter- 
pretation of  this  rule,  work  in  qualitative  analysis  may  be  counted 
as  general  inorganic  chemistry.  The  remaining  four  semester 
hours  required  shall  consist  of  work  in  organic  chemistry. 


40  KEQUIREMENTS  FOE   MATRICULATION 

(b)  Physics.  Eight  semester  lioius  required,  of  which  at  least 
two  must  be  laboratory  work.  This  course  presupposes  a  knowl- 
edge of  plane  trigonometry. 

(c)  Biology.  Eight  semester  hours  required,  of  which  four 
must  be  laboratory  work.  This  requirement  may  be  satisfied  by 
a  course  of  eight  semester  hours  in  either  general  biology  or  zoo- 
logy, or  by  courses  of  four  semestei'  hours  each  in  zoology  and 
botany,  but  not  by  botany  alone.  The  requirement  may  be  satis- 
fied also  by  6  semester  hours  of  college  biology,  including  three 
semester  hours  in  laboratory  work,  if  preceded  by  a  year  tone 
unit)  of  high  school  biology. 

(d)  English  COxMposition  and  Llterature.  The  usual  intro- 
ductory college  course  of  six  semester  hours,  or  its  equivalent,  is 
required. 

POST-GRADUATE  STUDENTS. 

Graduates  in  medicine  desiring  to  take  the  work  of  The  senior 
year  without  being  candidates  for  the  degree  and.  therefore,  with- 
out examination,  may  receive  a  certificate  of  attendance  on  com- 
pleting the  full  course  satisfactorily. 

The  requirements  for  graduates  in  medicine  admitted  to  the 
fourth  year  class  as  candidates  for  the  degree  of  Doctor  of  Medi- 
cine are  the  same  as  those  enforced  against  undergraduates  ad- 
mitted to  advanced  standing. 


COMBINED  COURSE  IN  ARTS  AND  MEDICINE. 

Students  who  have  completed  the  junior  year  in  our  School  of 
Liberal  Arts  and  who  have  made  an  approved  choice  of  electives 
may,  if  they  desire,  do  the  entire  work  of  the  senior  year  in  the 
medical  school  of  the  University.  If  they  successfully  complete 
the  work  of  the  first  medical  year  they  are  graduated  with  their 
class  with  the  degree  of  Bachelor  of  Arts. 

By  taking  advantage  of  this  privilege  a  man  may  complete  the 
Undergraduate  and  Medical  courses  in  seven  years. 

During  three  of  these  years  or  until  he  has  completed  the  work 
of  the  junior  class  he  is  a  resident  student  in  the  School  of  Lib- 
eral Arts  at  College  Park,  Maryland,  and  for  four  years  he  is  a 
student  in  the  Medical  School  in  Baltimore. 

At  the  end  of  the  fourth  year  he  receives  the  A.B.  degree,  and 
at  the  end  of  the  seventh  vear  the  M.D.  degree,  but  credit  from 


REQUIREMENTS  FOR.  MATRICULATION  41 

the  Medical  School  cannot  be  accepted  in  subjects  for  which  credit 
has  already  been  given  in  the  School  of  Liberal  Arts. 

The  same  privilege  is  allowed  students  of  St.  John's  College, 
Annapolis,  Maryland. 

Special  premedical  courses  have  been  arranged  in  our  School  of 
Liberal  Arts  at  College  Park  and  also  by  St.  John's  College  at 
Annapolis. 


RULES. 

1.  All  students  are  required  to  stand  the  spring  examinations 
unless  excused  by  the  Dean.  No  student  will  be  permitted  to 
advance  from  a  lower  to  a  higher  class  with  conditions. 

2.  Should  a  student  be  required  to  repeat  any  year  in  the  course 
he  must  pay  regular  fees. 

.3.  A  student  failing  in  final  examination  for  graduation  at  the 
end  of  the  fourth  year  will  be  required  to  repeat  the  entire  course 
of  tli»  fourth  year  and  to  take  examinations  in  such  other 
branches  as  may  be  required,  should  he  be  again  permitted  to 
enter  the  school  as  a  candidate  for  graduation. 

4.  The  general  fitness  of  a  candidate  for  graduation  will  be 
taken  into  consideration  by  the  Faculty  as  well  as  the  results  of 
his  examinations. 

All  the  above  rules,  as  well  as  the  fees  stated  below,  relate  to 
the  year  ending  June  1,  1922,  only.  The  right  is  reserved  to  make 
changes  in  the  curriculum,  requirements  for  graduation,  fees  and 
all  the  regulations  whenever  the  Faculty  deem  it  expedient. 


FEES. 

Matriculation  fee  (paid  each  year) $5.00 

Tuition  fee  (each  year) 250.00 

Brealvage  fee  (each  year) , 10.00 

Special  and  i"e-exauiination  fee 5.00 

I 

Ko  fees  are  returnable,  except  unused  portion  of  breakage  fee. 
Tuition  fees  are  due  and  payable  during  October. 
The  above  fees  apply  to  all  students  who  matriculate  in  this 
institution  in  any  class  for  the  session  beginning  October  3,  1921. 


42  PRIZES 

t^PECIAL  COURSES. 

Auatomy    $75.00 

Physiology    •. 75.(K) 

Pathology 7r..00 

Embryology 75.00 

Bacteriology    75.(K) 

Physiological  Chemistry   75.00 

I'harmacology    75.00 

Clinical  Laboratory    (four  months ) 100.00 

X-Ray    (four  months) 150.(t0 

Orthopedic   Surgery    (four  months) IjO.OO 

Genito-Urinary  Diseases  (four  months) 150.(h1 

Gynecology  and  Gynecological  Pathology 100.00-150.00 

(  6  weeks    $25.00 

Obstetrics.  Out-door ^^  ^  ^^^^^^^^^   .^^ 

(  6  weeks    50.00 

Out-Door  and  In-Door  j  ^  ^^^^^j^^    ^^^^ 

(Clinical  Surgery     ] 
SurgeryJ  Operative  Surgery  L By  arrangement 

I  Surgical  Pathology  I 

Medicine By  arrangement 

Laboratory  Technician  Course,  including  Bacteriology  and  Clinical 

Pathology    .$150.06 

If  the  courses  are  taken  during  holidays  or  if  special  super- 
vision is  desired  or  additional  material  required,  the  charge  is 
made  accordingly. 


FACT'LTY  PRIZE. 

To  stimulate  study  among  the  candidates  for  graduation,  the 
Faculty  offers  a  Gold  Medal  to  the  candidate  who  passes  the  best 
general  examination.  Certificates  of  Honor  are  awarded  tc  the 
five  candidates  standing  next  highest. 


.70S1-:  L.  TTIRSCH  PRIZE. 

A  prize  of  -$50.00  is  given  each  year  by  Mrs.  Jose  L.  Hirsch  as  a 
memorial  to  the  late  Jose  L.  Hirsch,  formerly  Professor  of  Path- 
ology in  this  school,  to  the  student  in  the  third  year  who  has  done 
the  most  satisfactorv  Avork  in  Pnthologv. 


SCHOLARSHIPS  43 

SCHOLAE  SHIPS. 

The  Dr.  Samuel  Leox  Frank  Scholarshu". 

This  scholarship,  established  by  Mrs.  Bertha  Kavner  Frank  as 
a  memorial  of  the  late  Dr.  Samuel  Leon  Frank,  an  alumnus  of 
this  T'niversitT.  entitles  the  holder  to  exemption  from  the  pay- 
ment of  the  tuition  fee  of  that  year. 

It  is  awarded  by  the  Trustees  of  the  Endowment  Fund  of  the 
University  in  each  year  upon  nomination  of  the  Medical  Council, 
"to  a  medical  student  of  the  University  of  Maryland,  who,  in  the 
judgment  of  said  Faculty,  is  of  good  character  and  in  need  of  pe- 
cuniary assistance  to  continue  his  medical  course." 

This  scholarship  is  awarded  to  a  second,  third  or  fourth  year 
student  only,  who  has  successfully  completed  one  year's  work  in 
the  medical  course,  and  no  student  may  hold  such  scholarship  for 
more  than  two  years. 

The  Charles  M.  Hitchcock  Scholarships. 

From  a  bequest  to  the  School  of  Medicine  by  the  late  Charles 
M.  Hitchcock,  M.D.,  an  alumnus  of  the  University,  two  scholar- 
ships have  been  established  which  entitle  the  holders  to  exemption 
from  payment  of  tuition  fees  for  the  year. 

These  scholarships  are  awarded  annually  by  the  Medical  Coun- 
cil to  students  who  have  meritoriously  completed  the  work  of  at 
least  the  first  year  of  the  course  in  medicine,  and  who  present  to 
the  Faculty  satisfactory  evidence  of  good  moral  character  and  of 
inability  to  continue  the  course  without  pecuniary  assistance. 

The  Randolph  Winslow  Scholarship. 

This  scholarship,  established  by  Prof.  Eandol]»h  Winslow,  M.D.. 
LL.D..  entitles  the  holder  to  exemption  from  the  payment  of  the 
tuition  fee  of  that  year. 

Ir  is  awarded  annually  by  the  Trustees  of  the  Endowment  Fund 
of  the  University,  upon  nomination  of  the  Medical  Council,  to  "a 
needy  student  of  the  Senior,  Junior,  or  Sophomore  Class  of  the 
Medical  School. 

"He  must  have  maintained  an  average  grade  of  85%  in  all  his 
work  up  to  the  time  of  awarding  the  scholarship. 

"He  must  be  a  person  of  good  character  and  must  satisfy  the 
Medical  Council  that  he  is  worthv  of  and  in  need  of  assistance" 


44  scholaeships 

The  University  Scholarships. 

Two  Scliolarsliips  are  awarded  by  the  University.  One  to  a  stu- 
dent of  the  Department  of  Liberal  Arts  appointed  by  the  Presi- 
dent; the  other,  which  entitles  the  holder  to  exemption  from 
payment  of  the  tuition  fee  of  the  year,  is  awarded  annually  by  the 
Medical  Council  to  a  student  of  the  Senior  Class  who  presents  to 
the  Medical  Council  satisfactory  evidence  that  he  is  of  good  moral 
character  and  is  worthy  of  and  in  need  of  assistance  to  complete 
the  course. 

The  St.  John^s  Scholarship. 

This  scholarship  is  awarded  annually  by  the  Medical  Council 
upon  the  nomination  of  the  President  of  St.  John's  College. 

It  entitles  the  holder  to  exemption  from  the  payment  of  the 
tuition  fee  of  that  year. 

Frederica  Gbhrmann  Scholarship. 

This  scholarship  was  established  by  bequest  of  the  late  Mrs. 
Frederica  Gehrmann  and  entitles  the  holder  to  exemption  from 
payment  of  tuition  fees.  This  scholarship  is  awarded  to  a  second 
year  student  who  at  the  end  of  the  year  passes  the  best  practical 
examination  in  Anatomy,  Physiology,  Physiological  Chemistry 
and  Pharmacology. 


NOTICE  TO  STUDENTS. 

The  personal  expenses  of  students  are  at  least  as  low  in  Balti- 
more as  in  any  large  city  in  the  United  States.  The  following- 
estimates  of  student's  personal  expenses  for  the  academic  year  of 
eight  months  have  been  prepared  by  students,  and  are  based  upon 
actual  experience: 

Itcnt.s.  Low. 

Books    $27 

College  Incidentals    20  ^ 

Hoard,  eight  mouths 200 

Room  rent C4 

Clothing  and  laundry .""lO 

All   other   expenses 25 

Total    Jr'38G  $029  $095 


cragc. 

Liberal. 

$48 

■    $75 

20. 

20 

250 

275 

80 

100 

80 

150 

50  • 

75 

OKGANIZATIOX    OF   THE   CUERICULUM  45> 


Students  will  save  time  and  expense  upon  Their  arrival  in  the 
city  by  going  direct  to  the  School  of  Medicine  on  the  rniversity 
grounds,  N,  E.  corner  of  Lombard  and  Greene  Streets,  where  the 
vSuperintendent  of  Building's,  who  may  be  found  at  his  office  on 
the  premises,  will  furnish  them  with  a  list  of  comfortable  and 
convenient  boarding  houses  suitable  to  their  means  and  wishes. 

The  Dean  will,  if  desired,  attend  to  the  collection  of  checks  and 
drafts  for  students. 

For  further  information  apply  to 

J.  M.  H.  Rowland.  M.D..  Deon, 
Lombard  and  Greene  Streets. 


ORGA^'IZATION  OF  THE  CURRICULUM. 

The  following  curriculum  is  the  result  of  a  thorough  re 
vision  of  teaching  in  this  school  in  order  to  meet  modern  re- 
quirements. The  multiplication  of  specialties  in  medicine  and 
surgery  necessitates  a  very  crowded  course  and  the  introduction 
of  electives  will  very  soon  be  depended  on  to  solve  some  of  the 
difficulties. 

The  curriculum  is  organized  under  eleven  departments: 

1.  Anatomy  (including  Histology  and  Embryology). 

2.  Physiology. 

3.  Chemistry   (including  Physiological  Chemistry). 

4.  Pharmacology  and  Materia  Medica. 

5.  Pathology. 

6.  Bacteriology. 

7.  Medicine  (including  Medical  Specialties). 

8.  Surgery  (including  Surgical  Specialties  i . 

9.  Obstetrics. 

10.  Gynecology. 

11.  Ophthalmology  and  Otology. 

The  instruction  is  given  in  four  years  of  graded  work. 

Several  courses  of  study  extend  through  two  years  or  more,  but 
in  no  case  are  the  students  of  different  years  thrown  together  in 
the  same  course  of  teaching. 

The  first  and  second  years  are  devoted  largely  to  the  study  of 
the  structures  and  functions  of  the  normal  body,  and  laboratory 
work  occupies  most  of  the  student's  time  during  these  two  years. . 


4(j  ORGAiN'IZATIOX    OF  THE   CUKKICULUM 

Home  iutiofluctory  instruction  in  Medicine  and  Surgery  is  given 
in  the  second  year.  The  third  and  fourth  years  are  almost  en- 
tirely clinical. 

A  special  feature  of  instruction  in  the  school  is  the  attempt  to 
bring  together  teacher  and  student  in  close  personal  relationship. 
In  many  courses  of  instruction  the  classes  are  divided  into  small 
groups  and  a  large  number  of  teachers  insures  attention  to  the 
needs  of  each  student. 

In  many  courses  the  tinal  examination  as  the  sole  test  of  pro- 
ficiency has  disappeared  and  the  student's  final  grade  is  deter- 
mined largely  by  partial  examinations,  recitations  and  assigned 
work  carried  on  throughout  the  course. 

AKRAIVGEMENT  OF  CLASSES. 

All  the  teaching  of  the  freshman  class  is  done  at  Calvert  and 
>>aratoga  Streets.  All  the  teaching  of  the  sophomore  class  is  done 
at  Lombard  and  Greene  Streets. 

The  junior  class  has  three  hours  of  didactic  teaching  each  morn- 
ing. For  clinical  instruction  and  laboratory  work  this  class  is 
divided  into  two  sections  and  the  year  into  semesters.  Each  sec- 
tion will  work  for  one  semester  at  the  University  Hospital  and 
one  semester  at  Mercy  Hospital. 

The  senior  class  is  divided  into  two  sections  and  for  this  class 
I  he  year  is  divided  into  semesters.  Each  section  receives  clinical 
instruction  for  one  semester  in  the  University  Hospital  and  the 
Mercy  Hospital.  In  the  afternoon  the  whole  class  is  assembled 
and  has  two  hours  of  didactic  teaching  each  day. 

This  distribution  of  the  classes  is  made  in  order  to  utilize  to 
the  best  advantage  the  laboratory  space  and  to  bring  the  students 
into  daily  contact  with  patients  in  both  of  the  hospitals  and  dis- 
pensaries. 

DEPARTMENT  OF  ANATOMY,  INCLUDING  HISTOLOGY  AND 
EMBRYOLOGY. 

C.  T>.  Davis.  M.D Professor  of  Anatomy 

TiLGiiMAX  B.  Marden,  A.B.,  M.D., 

I'rofessor  of  Histology  and  Embryology  and  Assistant  in  Anatomy 

.7.  W.  Holland,  M.D Associate  Professor  of  Anatomy 

M.  ,].  Hanna.  M.D Assistant  in  Anatomy 

First  Year.  Didactic.  Five  hours  each  week  for  thirty-two 
weeks.  Each  day,  preceding  the  laboratory  period,  a  quiz  and 
demonstration  of  from  40  to  50  minutes  is  held,  covering  the  lab- 
oratory work  for  the  day. 


ORGANIZATION    OF   THE   CUERICULUM  47 

Laboratory.  Eighteen  hours  each  week  for  sixteen  weeks. 
Twelve  hours  each  week  for  sixteen  weeks.  This  course  includes 
a  complete  dissection  of  the  human  body,  including  the  central 
nervous  system.  Abundance  of  good  material  is  furnished  and 
the  student  is  aided  in  his  work  by  competent  demonstrators. 
Practical  examinations  are  held  at  frequent  intervals  throughout 
the  session  and  each  student  will  be  held  to  strict  account  for 
material  furnished  him.  Each  student  is  furnished  a  skeleton  and 
a  deposit  is  required  to  insure  its  return  in  good  condition  at  the 
end  of  the  session. 

Second  Year.  Didactic.  Three  hours  each  week  for  six  weeks. 
Lectures,  recitations  and  conferences. 

Laboratory.  Seven  hours  each  week  for  six  weeks.  This  course 
is  devoted  exclusively  to  Neuro-Anatomy.  A  complete  dissection 
of  the  human  brain  is  required.  This  is  followed  by  a  study  of 
the  tiber  tracts  of  the  spinal  cord  and  brain,  special  models  and 
preparations  being  used  for  this  part  of  the  course. 

Histology. 

First  Year.  Lectures,  recitations  and  laboratory  work,  nine 
hours  each  week  during  first  semester;  three  hours  each  week 
during  second  semester.  The  most  important  part  of  the  work 
will  be  done  in  the  laboratory,  where  each  student  will  be  pro- 
vided with  a  microscope,  apparatus,  staining  fluids  and  material 
necessary  for  the  preparation  of  specimens  for  microscopical  ex- 
amination. An  important  aid  to  the  course  is  the  projection 
microscope  which  is  used  for  the  projection  upon  a  screen  of  mag- 
nified images  of  the  specimens  actually  used  in  the  laboratory. 

A  large  number  of  completely  prepared  sections  are  loaned  to 
the  students  for  study.  This  materially  reduces  the  time  other- 
wise required  by  the  student  for  the  preparation  of  sections  and 
insures  the  best  possible  class  of  materia]  for  study. 

Embryology. 

i.ectures,  recitations  and  laboratory  work;  six  hours  each  Aveek 
during  the  second  semester. 

This  course  includes  the  study  of  the  development  of  the  chick, 
nnd  the  fundamental  principles  of  mammalian  embryology.  In 
the  laboratory,  the  hen's  egg  will  be  studied  in  its  various  stages 
nf  development,  and  sections  of  the  chick  at  different  ]^eriods  of 


4S  OEGANIZATIOX    OF   THE  CUEKICULUM 

iuciibatiou  Mill  be  made  aud  studied  microscopically.  The  latter 
part  of  the  course  will  be  devoted  to  the  study  of  sections  through 
dift'erent  regions  of  a  mammal. 

tUpecial  emphasis  is  laid  upon  the  development  in  the  human. 

DEPARTMENT  OF  PHYSIOLOGY. 

Bautgis  McGlone,  A.B.,  Ph.D..  F.O.C.P Professor  of  Physiology 

Charles  C.  Conser,  M.D As.sociate  Professor  of  Physiology 

Harold  E.  Wright,  M.D Instructor  iu  Physiology 

FiRMADGE  K.  Nichols.  M.D Assistant  iu  Physiology 

The  course  in  Physiology  extends  throughout  the  First  and  Sec- 
ond Years.  It  consists  of  a  series  of  lectures,  covering  the  field  of 
human  physiology,  laboratory  work,  demonstrations,  and  frequent 
recitations.  It  is  constantly  in  the  mind  of  the  department  that 
this  course  is  introductory  to  the  study  of  medicine.  The  recita- 
tions cover  the  subject-;natter  of  the  lectures  and  the  experiments 
performed  in  the  laboratory. 

First  Year.  1.  This  course  includes  lectures  and  recitations 
upon  the  physiology  of  the  blood  and  circulation,  respiration, 
muscle  and  nerve,  a  portion  of  the  central  nervous  system,  and 
special  senses,  and  such  chemical  and  physical  facts  as  are  neces- 
sary for  a  proper  undei*standing  of  the  physiology  taught.  Tw'O 
lectures  and  a  recitation  weekly  throughout  the  year.  Dr.  Mc- 
Glone, assisted  by  Dr.  Wright. 

Second  Year.  2.  Didactic  instruction.  During  this  year  the 
remaining  topics  of  physiology  are  covered  by  lectures  and  demon- 
strations. As  in  the  first  year  frequent  recitations  will  be  held. 
The  subject-matter  includes  the  physiology  of  digestion  and  secre- 
tion, nutrition,  metabolism,  internal  secretion,  and  the  cranial 
central  nervous  system.  Lectures,  demonstrations,  and  recita- 
tions, three  hours  per  week.  Dr.  McGlone,  assisted  by  Dr.  Con- 
ser. 

:^>.  Experimentnl  Pluf^iiolog}/.  This  is  a  laboratory  course  in  the 
dynamics  of  muscle  and  nerve,  studies  in  circulation  and  respira- 
tion, and  physiology  of  the  special  senses.  Apart  from  the  acqui- 
sition of  the  facts  of  physiology,  the  student  is  taught  to  observe 
accurately,  record  carefully  the  results  of  his  observations,  and 
from  these  results  draw  an  independent  conclusion.  He  is  also 
trained  in  the  use  of  instruments  which  are  of  value  to  him  in  his 
clinical  years.  Three  hours  weekly  throughout  the  year.  Drs. 
McGlone,  Conser  and  Wright. 


OEGANIZATIOX   OF   THE  CrRBICULUM  49 

4.  Elective  Course  in  Physiological  Technique.  This  course  is 
offered  to  Sophomores.    Three  hours  per  week.     Second  semester. 

5.  Special  Mammaltaii  Physiology.  This  is  a  laboratory  course 
intended  for  advanced  Laboratory  students  (optional)  who  may 
wish  to  do  special  work  in  this  line  of  physiology.  Hours  to  be 
arranged.    Dr.  McGlone. 

6.  Research  in  Physiology.  Properly  qualified  students  will  be 
admitted  to  the  laboratory,  which  is  well  adapted  for  post  gradu- 
ate study  and  special  research.  Hours  will  be  arranged  to  suit 
individuals.    Dr.  McGlone. 

PHARMACOLOGY  AND  MATERIA  MEDICA. 

William  Hexky  Schcltz.  Ph.B.,  Ph.D Professor  of  Pharmacolog>' 

O.  Glenn  Harne,  A.B Associate  Professor  of  Pharmacology 

1.  Pharmacology.  Materia  Medica  and  Prescription  Writing 
required  of  all  second  year  medical  students  during  the  first 
semester.  Didactic,  three  hours  a  week ;  Laboratory,  three  hours 
a  week. 

This  course  is  a  prerequisite  to  all  other  courses  in  Pharma- 
cology. Special  emphasis  is  laid  upon  laboratory  methods  of  ob- 
servation and  of  intelligent  note-taking.  The  essentials  of  pre- 
scription writing  are  taught  and  the  student  is  introduced  to  the 
oflScial  pharmacopoeal  preparations. 

Xot  only  is  the  student  taught  intelligently  to  use  the  United 
States  Pharmacopea  and  the  National  Formulary,  but  the  princi- 
ples underlying  the  establishing  of  some  of  the  most  practical 
receipts  are  attacked  from  a  didactic  point  of  view, 

2.  Systematic  Ph<irmacology.  Eequired  of  all  second  v^ear  medi- 
cal students.  Three  hours  a  week  during  the  year,  tAvo  lecture 
periods  and  one  period  for  quiz  and  general  conferences.  Special 
care  is  taken  to  adapt  the  material  to  the  practical  needs  of  the 
medical  student.  *  Emphasis,  however,  is  laid  upon  the  pharmaco- 
logical action  of  drugs  as  a  pure  science  in  order  that  a  critical 
attitude  toward  drugs  may  be  instilled.  As  the  student  masters 
the  pharmacology  of  an  important  drug,  its  dosage,  incompatibili- 
ties, and  practical  applications  are  driven  home  by  systematic 
assignments  of  prescription  writing,  quizes,  and  conferences. 

3.  Pharmacodynamics. — Second  semester.  Eequired  of  all  sec- 
ond year  medical  students.  Prerequisite  pharmacology  1.  Lab- 
oratorv,  six  hours  a  week. 


•50  ORGAXIZATIOX    OF  THE  CURRICULUM 

The  course  runs  parallel  with  pharmacology  2.  Being  a  labora 
lory  course  it  furnishes  much  didactic  material  used  in  the  class 
conterences  and  lectures  of  pharmacology  No.  2. 

As  the  student's  ability  in  handling  biological  material  de- 
velops, experiments  involving  the  more  difficult  technic  of  phar- 
macological experimentation  are  introduced.  Special  emphasis  is 
laid  upon  the  student's  ability  to  handle  live  tissues  and  to  make 
first-hand  observations  of  a  given  drug's  action,  regardless  of 
what  standard  text-books  teach. 

Class  conferences,  discussions,  and  the  reading  of  assigned  pa- 
pers are  used  to  supplement  the  laboratory  and  lecture.  lu  these 
conferences  the  professor  in  charge  attempts  to  summarize  the 
class  work  as  a  whole,  thereby  properly  coordinating  it.  It  is  by 
these  means  that  the  student  acquires  a  critical  and  scientific  atti- 
tude toward  official  and  neic  and  non-official  remedies.  The  study 
is  limited  for  the  most  part  to  such  drugs  as  are  known  to  have  a 
<]efinite  pharmacological  action  and  therapeutic  value. 

4.  Special  Pharmacodynamics.  (Credit  according  to  work  done.  I 
This  course  is  open  to  advance  students  and  special  workers 

who  desire  advanced  training,  or  who  wish  to  pursue  some  special 
problem  in  Pharmacolog}'  or  Toxicology.  Hours  to  be  arranged. 
Professor  Schultz. 

5.  Research  in  Pharmacology  and  Chemo-Theiapy.  Properly 
qualified  students  are  admitted  to  the  laboratory  Avith  a  view  to 
their  carrying  on  original  investigations  in  drug  action.  The 
newly  equipped  laboratories  are  well  adapted  for  post-graduate 
study  and  research  in  Pharmacology.  Hours  will  be  arranged  to 
suit  the  applicant.    Professor  Schultz. 

DEPARTMENT  OF  PATHOLOGY. 

Hugh  R.  Spencer,  M.D Professor  of  Pathology 

Standish  McCr.EARY.  M.D Professor  of  Pathology 

♦Sydney  Cone.  M.D Associate  Professor  of  Pathology 

Wm.  J.  Carson.  M.D Associate  Professor  of  Pathology 

Richard  Dresser.  M.D Assistant  iu  Pathology 

Courses  of  instruction  in  pathology  are  given  during  the  sec- 
ond, third  and  fourth  years.  The  courses  are  based  on  previous 
study  of  normal  structures  and  functions  and  aim  to  outline  the 
natural  history  of  disease.  The  instruction  is  made  as  practical 
as  ])Ossible  that  the  student  may  become  familiar  with  the  appear- 
ance of  organs  and  tissues  iu  disease  and  may  be  able  to  correlate 
anatomical  lesions  with  clinical  symptoms  and  signs. 


ORGANIZATION    OF  THE   CURRICULUJM  51 

1.  General  Pathology  and  Histo-pathology.  This  course  l^4 
given  to  second  year  students,  it  includes  the  study  and  demon- 
stj^ation  of  disturbances  of  the  body  fluids,  disturbances  of  struc- 
ture, nutrition  and  metabolism  of  cells,  disturbances  of  fat,  car- 
bohydrate and  protein  metabolism,  disturbances  in  pigment  met- 
abolism, inflammation  and  tumors.  The  laboratory  course  con- 
sists in  a  daily  preliminary  lecture,  after  Avhich  the  student  is 
given  microscopical  sections  for  study,  (iross  material  from 
autopsy  and  from  the  museum  is  demonstrated  in  conjunction 
with  the  microscopical  study. 

2.  Applied  Pathology^  including  Gross  Morbid  Anatomy  and 
Morbid  Physiology.  Third  year  students:  In  this  course  the 
special  relationship  of  the  gross  and  microscopical  lesions  to  clin- 
ical symptoms  and  signs  is  emphasized.  Fresh  material  from 
autopsy  collected  at  the  various  hospitals  is  demonstrated  and 
supplemented  by  a  study  of  the  respective  autopsy  protocols. 

Special  stress  is  laid  upon  the  study  of  the  infectious  diseases 
and  where  possible  the  causative  agents  are  studied. 

3.  Autopsies.  Third  year.  Autopsy  technic  is  taught  to  small 
groups  of  students  by  special  instruction  a^  autopsies  performed 
at  the  various  hospitals.  Students  are  required  to  assist  at  the 
autopsy,  study  the  organs,  examine  the  microscopical  sections, 
make  cultures  and  prepare  autopsy  protocols. 

4.  Clinical  Pathological  Conference.  Fourth  year.  Mate- 
rial from  autopsies  is  studied  with  reference  to  the  clinical  history 
and  gross  and  microscopical  anatomj',  the  course  is  illustrated 
with  sections  of  fixed  material  or  lantern  slides. 

5.  Advanced  Work  in  Pathology.  Properly  qualified  students 
will  be  permitted  to  carry  out  advanced  or  research  work  along 
the  lines  of  experimental  pathology.  Adequate  space  and  equip- 
ment is  available. 

DEPARTMENT  OF  BACTERIOLOGY  AND  IMMUNOLOGY. 

Wm.  Royal  Stokes,  M.D.,  Sc.D Professor  of  Bacteriologj- 

Frank  W.  Hachtel.  M.D Associate  Professor  of  Bacteriologj- 

Instruction  in  special  bacteriology  is  given  in.  the  laboratory  to 
the  students  of  the  first  year  during  one  semester.  This  includes 
the  various  methods  of  sterilization  and  preparation  of  culture 
material,  the  study  of  pathogenic  microorganisms  of  vegetable 
origin,  and  the  bacteriological  study  of  water,  milk,  sewage,  and 
other  such  materials.  The  bacteriological  diagnosis  of  the  infec- 
tious diseases  is  also  included  in  this  course.     Animal  inocula- 


■DZ  OEGAXIZATIOX   OF  THE   CUERICULUM 

tions  and  autopsies  are  performed  in  connection  with  the  bacteria 
.studied  and  diagnoses  by  means  of  serum  reactions  are  also  given. 
In  the  third  year  the  various  animal  parasites  are  demonstrated 
and  the  diseases  produced  by  these  organisms  studied  by  means 
of  gross  specimens,  stained  sections  and  lantern  slides.  The  prin- 
ciples of  general  bacteriology  are  taught  in  didactic  lectures  given 
once  a  week  throughout  the  entire  first  year,  and  these  lectures 
include  the  structure  of  bacteria,  the  various  facts  concerning 
their  biological  properties,  infection  and  immunity. 

The  general  principles  of  immunology  are  described  in  a  weekly 
lecture  to  the  second  year  class  throughout  the  firs^t  semester  and 
practical  experiments  in  immunology  are  demonstrated  to  the 
second  year  class  in  laboratory  sessions  of  two  hours  held  thrice 
weekly  throughout  the  first  semester. 

DEPARTMENT  OF  PHYSIOLOGICAL  CHEMISTRY. 

K.  Boyd  Wvlie,  M.D Professor  of  Physiological  Cliemistry 

Frank  N.  Ogden,  M.D Instructor  iu  Pliysiological  Cliemistry 

The  course  in  Physiological  Chemistry  comprises  laboratory 
work,  special  laboratory  demonstrations,  lectures  and  discussions 
of  extracts  prepared  by  students,  from  current  literature. 

Laboratory  Work.  The  regular  class  work  in  the  laboratory 
is  carried  on  in  two  sections,  throughout  the  year,  each  section 
spending  Tuesday  or  Thursday  morning  from  9-12  in  the  labora- 
tory. 

During  these  first  periods,  study  is  directed  to  the  chemistry 
of  proteins,  carbohydrates,  fats  and  extractives.  Later  these 
substances  are  subjected  to  the  action  of  enzymes,  and  such  hy- 
drolytic  products  capable  of  production  in  the  laboratory  are 
studied.  Following  this  work,  the  main  tissues  of  the  body,  along 
with  its  chief  secretions  and  excretions,  are  investigated.  The 
former,  briefly;  the  latter,  more  thoroughly;  a  great  deal  of  atten- 
tion being  given  to  the  quantitative  estimations  of  blood,  urine, 
feces  and  stomach,  contents. 

Special  Laboratory  Demonstrations.  These  special  demon- 
strations take  place  three  afternoons  a  week,  during  the  second 
semester.  A  group  of  six  or  eight  men  are  assigned  to  the  execu- 
tion of  the  more  complicated  tests  on  blood,  urine,  gastric  con- 
tents and  feces.  In  this  work,  emphasis  is  laid  ou.  those  tests 
which  ))ear  more  or  less  on  pathol(»gical  conditions. 

Ample  opportunity  is  aft'orded,  in  this  afternoon  work,  for  ex- 
perimentation with  new  methods  and  for  reseach  work. 


CLINICAL   I^^STEUCTION  53 

Lectures.  The  lectures  are  given  in  one  hour  periods,  for  three 
days  a  week.  They  are  designed  to  furnish  the  student  with  a 
clear  understanding  of  the  practical  work,  and  at  the  same  time, 
to  supply  the  theoretical  material  necessary  to  complete  a  well- 
rounded  course.  Wherever  of  practical  benefit  to  the  student,  the 
abnormal  as  well  as  the  physiological  aspects  of  the  subject  under 
discussion  are  always  considered. 

Extracts  of  Current  Literature  by  Students.  This  depart- 
ment was  instituted  to  stimulate  the  student's  interest  in  the 
concurrent  literature  associated  with  this  subject. 

Periodically,  during  the  year,  students  are  appointed  to  present 
to  the  class  extracts  of  articles  of  special  interest  from  a  physio- 
logical chemical  standpoint.  The  paper  thus  presented  is  dis- 
cussed by  other  students,  previously  appointed  for  the  purpose. 

MEDICAL  JURISPRUDENCE. 

H.  J.  Maldeis.  M.D Baltimore  City  Post  Mortem  Physician 

Third  Year.    One'hour  each  week  for  one  semester. 

Inasmuch  as  Medical  Jurisprudence  teaches  the  application  of 
every  branch  of  medical  knowledge  to  the  needs  of  law,  civil  or 
criminal,  this  course  embraces  the  following: — Proceedings  in 
criminal  and  civil  prosecution ;  medical  evidence  and  testimony ; 
identity  in  its  general  relations ;  sexual  abnormalities ;  personal 
identity ;  impotence  and  sterility :  rape ;  criminal  abortions ;  signs 
of  death;  wounds  in  their  medico-legal  relations;  death,  natural 
and  homicidal ;  malpractice ;  insanity  and  medico-legal  autopsies. 


CLINICAL  INSTRUCTION. 

DEPARTMENT  OF  SURGERY. 

Arthur  M.  Shipley,  M.D Professor  of  Surgery 

Archibald  C.  Harrison,  M.D Professor  of  Surgery 

Alexius  McGlannan,  A.M.,  M.D Professor  of  Surgery 

Joseph  H.  Branham,  M.D Professor  of  Clinical  Surgery 

Nathan  Winslow,  A.M.,  M.D Clinical  Professor  of  Surgery 

Walter  D.  Wise,  M.D Clinical  Professor  of  Surgery 

Joseph  W.  Holland,  M.D Clinical  Professor  of  Surgery 

J.  C.  Lumpkin,  M.D Clinical  Professor  of  Surgery 

William  W.  Requardt.  M.D Associate  Professor  of  Surgery 


54  CLINICAL,   INSTRUCTION 

H.  C.  Blake,  M.D Associate  Professor  of  Clinical  Surgery 

Frank  S.  Lynn.  M.D Associate  Professor  of  Surgerj- 

Elliott  H.  Hutchins,  A.M.,  M.D Associate  Professor  of  Surgery 

Thomas  R.  Chambers,  A.M.,  M.D Associate  Professor  of  Surgery 

R.  W.  LocHER,  M.D.  .Associate  Professor  of  Operative  and  Clinical  Surgery 

E.  H.  Hayward,  M.D Associate  in  Surgery 

Frank  J.  Kirby,  M.D Associate  in  Surgery 

F.  L.  Jennings,  M.D .Instructor  in  Surgery 

A.  M.  Evans,  M.D Instructor  in  Surgery 

E.  P.  Smith,  M.D Instructor  in  Operative  Surgery 

Charies  Reid  Edwards,  M.D Instructor  in  Surgery 

H.  M.  Foster,  M.D Instructor  in  Surgery 

E.  S.  Johnson,  M.D Instructor  in  Surgery 

F.  X.  Kearney,  M.D Assistant  in  Surgery 

G.  W.  Bowden,  M.D Assistant  in  Surgei'y 

DwiGHT  MoHB,  M.D Assistant  in  Surgerj- 

Amos  Hutchins,  M.D Assistant  in  Surgery 

C.  A.  Reifschneider,  M.D Assistant  In  Surgery 

Wm.  R.  Geraghty,  M.D Assistant  in  Surgery 

S.  Demarco,  M.D Assistant  in  SurgeiT 

O.  H.  Lloyd,  M.D Assistant  in  Surgery 

Clyde  Marvel,  M.D .Assistant  in  Surgery 

Everard  Briscoe,  M.D Assistant  in  Surgery 

The  teaching  is  in  the  Anatomical  Laboratory  and  the  dispen- 
saries, wards,  clinical  laboratories  and  operating  rooms  of  the 
University  and  Mercy  Hospital,  and  in  the  wards  and  dead-honse 
of  the  Municipal  Hospitals  at  Bay  View. 

Instruction  is  given  by  means  of  lectures,  recitations,  dispen- 
sary work,  bedside  instruction,  ward-classes,  and  clinics.  The 
work  begins  in  the  second  year,  and  continues  throughout  the 
third  and  fourth  years. 

Second  Year. 

Topographic  and  surgical  anatomy,  15  hours  a  week  for  the  first 
semester.  The  course  is  designed  to  bridge  the  gap  between 
anatomy  in  the  abstract,  and  clinical  anatomy  as  applied  to  the 
study  and  practice  of  medicine  and  surgery. 

The  teaching  is  done  in  the  anatomical  laboratory,  and  students 
are  required  to  demonstrate  all  points,  outlines,  and  regions  on 
the  cadaver.  Underlying  regions  are  dissected  when  necessary  to 
bring  out  outlines  and  relation  of  structures.  Didactic  lectures 
two  hours  weekly,  augmented  by  demonstrations  with  specimens, 
charts,  and  cross-sections.     Dr.  Holland. 


CLINICAL    INSTRUCTIOlSr  55 

SURGICAL  TECHNIQUE. 

The  course  includes  history  taking,  first  aid  treatment,  demon- 
stration of  use  of  tourniquet  and  other  emergency  appliances  and 
f?urgical  dressings,  bandages,  plaster,  adhesive  plaster,  suture  ma- 
terial, solutions;  their  preparation  and  use. 

It  includes  also  non-operative  therapeusis,  asepsis  and  anti- 
sepsis, the  study  of  circulatory  and  respiratory  failure,  prepara 
tion  of  patients,  dummy  operations  and  written  description  of 
operation,  splints,  bed  frames,  bone  plates,  grafts  and  local  an 
aesthesia. 

Lectures  and  conferences,  two  hours  a  week  for  one  semester. 
Dr.  Edwards. 

Third  Year. 

Principles  of  surgery  and  general  surgery,  two  and  a  half  hours 
a  week  throughout  the  year  to  the  entire  class,  lectures,  recita- 
tions, and  clinics.    Dr.  Shipley. 

The  class  is  divided  into  groups  and  receives  instruction  in  his- 
tory-taking, gross  pathology,  and  surgical  diagnosis — at  the  bed- 
side and  in  the  deadhouse  of  the  Municipal  Hospitals  at  Bay 
View.    Drs.  Shipley,  Lynn  and  Dresser. 

Operative  Surgery.  Instruction  is  given  in  operative  surgery 
upon  the  cadaver  and  on  dogs.  The  class  is  divided  into  sections, 
and  each  section  is  given  practical  and  individual  work  under  the 
supervision  of  the  instructors.  Dr.  Frank  S.  Lynn,  assisted  by 
Drs.  Locher,  Hayward,  E.  S.  Johnson,  N.  Winslow,  Edwards, 
Foster,  Eeifschneider,  Geraghty  and  Demarco. 

Fractures  and  Dislocations.  One  hour  a  week  for  one  semester. 
This  course  consists  of  instruction  in  the  various  forms  of  frac- 
tures and  dislocations  and  their  treatment,  and  serve  as  a  prepar- 
atory course  for  clinical  work.    Dr.  Wise. 

Surgical  Dispcnsarjj.  Lender  supervision,  the  student  takes  the 
history,  makes  the  physical  examination,  attempts  the  diagnosis, 
and.  as  far  as  possible,  carries  out  the  treatment  of  the  ambu- 
latory surgical  cases  in  the  University  and  Mercy  Hospitals. 
Mercy  Hospital — Drs.  Amos  Hutchins,  Mohr,  A.  M.  Evans, 
\Mieatou,  Kearney,  Lloyd  and  Marvel.  I^niversity  Hospital — 
r»rs.  Edwards.  E.  S.  Johnson  and  Foster. 

Fourth  Year. 

Regional  Surgerg.  Surgery  of  the  abdomen  and  abdominal 
wail,  including  hernia.  Two  hours  a  week  for  (me  semester  to  the 
entire  closs.     Dr.  Harrison. 


56  •  CLINICAL   INSTRUCTION 

Surgery  of  the  head,  neck,  spine,  and  chest.  Two  hours  a  week 
for  one  semester  to  the  entire  class.    Dr.  McGlannan. 

Clinics.  A  weekly  clinic  will  be  given  at  the  Mercy  and  Uni- 
versity Hospitals  to  one-half  the  class  throughout  the  year.  As 
far  as  possible  this  is  a  diagnostic  clinic.  Mercy  Hospital — Drs. 
Harrison  and  McGlannan.     University  Hospital — ^Dr.  Shipley, 

Surgical  Pathology.  A  weekly  exercise  of  one  hour  at  Mercy 
Hospital  for  one  semester,  at  which  specimens  from  the  operat- 
ing-room and  museum  are  studied  in  the  gross  and  microscopi- 
cally, in  relation  with  the  case  history.    Dr.  McGlannan. 

Industrial  Surgery.  Operative  and  post-operative  treatment 
of  accident  cases,  with  instructions  as  to  the  relationship  between 
the  state,  the  employee,  and  employer,  and  the  physician's  duty  to 
each.  One  hour  a  week  to  sections  of  the  class  throughout  the 
year.    Dr.  Edmunds. 

Clinical  ClerksJiip.  The  personal  study  of  assigned  hospital 
patients,  under  supervision  of  the  staffs  of  University  and  Mercy 
Hospitals,  history  taking,  and  physical  examinations  of  patients, 
laboratoiy  examinations,  attendance  at  operations  and  observa- 
tion of  post-operative  treatment. 

Ward  Classes.  Ward  class  instruction  in  small  groups,  will 
consist  of  ward  rounds,  surgical  diagnosis,  treatment  and  the 
after  care  of  operative  cases.  Mercy  Hospital — Drs.  Harrison, 
McGlannan,  Wise,  Elliott  Hutchins,  Evans  and  Locher.  Univer- 
sity— Drs.  Shipley,  Holland,  Edmunds  and  Lynn. 

ANAESTHESIA. 

Third  Year. 

Lectures  on  the  history  of  anaesthesia,  general  physiology  of 
inhalation  of  anaesthetics,  special  physiology  of  each  anaesthetic, 
methods  of  administration,  inhalation,  colonic,  intravenous,  com- 
plications and  preventive  methods,  including  artificial  respiration 
and  post-anaesthesia  treatment  of  patients.  One  hour  weekly  for 
one  semester.    Dr.  S.  Griffith  Davis. 

Anaesthesia  in  obstetrics,  one  lecture.    Dr.  J.  McF.  Bergland. 

Fourth  Year. 

During  the  clinics  and  operations  before  small  groups,  each  stu- 
dent will  be  required  to  administer  anaesthetic  under  the  direc- 
lion  of  an  instructor.  University  Hospital — Drs.  Queen  and 
^foore.    Mercy  Plospital — Drs.  Kearney  and  Kidgely. 


CLINICAL    INSTEUCTION  57 

DERMATOLOGY. 

T.  Caspar  Gilchrist,  M.R.C.S.,  L.S.A.,  M.D Professor  of  Dermatology 

Melvin  Rosenthal,  M.D Associate  Professor  of  Dermatology 

John  R.  Abercrombie,  A.B..  J.D Associate  Professor  of  Dermatology 

Harry  M.  Robinson.  M.D Associate  in  Dermatology 

Joseph  E.  Gately,  M.D Assistant  in  Dermatology 

Clinical  conference  one  hour  each  week  to  entire  class.  This 
course  will  consist  of  demonstrations  of  the  common  diseases  of 
the  skin.     Dr.  Gilchrist. 

Dispensary  instruction,  l^niversity  Hospital,  Mondays,  Wednes- 
days and  Fridays  in  the  diagnosis  and  treatment  of  the  common 
skin  diseases.  Dr.  Abercrombie.  Dispensary  instruction,  Mercy 
Ilospiral,  Dr.  Rosenthal. 


ORTHOPAEDIC  SURGERY. 

R.  Tunstall  Taylor.  A.B..  M.D Professor  of  Orthopedic  Surgery 

Albertus  Cotton.  A.M..  M.D Professor  of  Orthopedic  Surgery 

CoMPTON  RiELY.  M.D Cliiiical  Professor  of  Orthopedic  Surgery 

Sydney  M.  Cone.  A.B..  M.D Clinical  Professor  of  Orthopedic  Surgery 

W.  H.  Daniels,  M.D Demonstrator  in  Orthopedic  Surgery 

W.  Arthur  Darby,  M.D Demonstrator  in  Orthopedic  Surgery 

H.  L.  Wheeler,  M.D Demonstrator  in  Orthopedic  Surgery 

In  this  course  didactic,  clinical,  bedside  and  out-patient  instruc- 
tion will  be  given.  This  instruction  is  provided  in  the  University 
Hospital  Amphitheater  and  Dispensary,  Mercy  Hospital  and  Dis- 
pensary and  Kernan  Hospital  and  Industrial  School  for  Crippled 
Children  at  ''Radnor  Park,"  and  in  the  Dispensary  of  same  at 
Gl'O  West  Lombard  Street. 

Lectures,  clinics  and  quizzes  will  be  held  at  each  of  the  hospi- 
tals once  a  week.  In  addition,  a  weekly  bedside  clinic  will  be  held 
for  smaP  sections  of  the  class  at  "Radnor  Park." 

Tlie  course  will  cover  instruction  in  special  methods  and  in- 
struments required  in  this  surgical  specialty,  including  X-Ray 
trcliuique;  Wolff's  law;  tuberculosis  of  bones  and  joints;  defor- 
mities of  the  feet;  non-tuberculous  deformities  of  the  feet  and 
joints;  the  paralyses;  the  bursal,  tendinous  and  muscular  condi- 
tions producing  orthopedic  affections;  rickets;  scurvy;  osteoma- 
lacia; chondrodystrophies;  wry-neck  and  the  use  and  application 
of  orthopedic  apparatus. 


08  CLIXIOAL    lA^STBUCTIOX 

ROENTtJENOLOGY  AXD  RADIOTHERAPY. 

llKNUY  J.  Wai.tox.  M.l  > Professdi-  of  l{oeutiieii<ilo;iy 

Albektus  (]'otton.  A.m..  M.I  > I'rofessor  of  Koeutsenology 

John  Evans.  M.1> Associate  Professor  of  Roeiitj;eiiology<i 

Chaklks  Rf.11)  Kdwakds.  A.P>..  M.]) Iiistnictoi'  in  Koeiitiieiiolojjy 

(iisliuetioii  is  liiveii  in  ilie  hisloiy,  physics,  jiiid  ]»i:u(ica]  ap- 
]ilica;i(>n  of  Roentgen  Kays  and  Kadiuni.  Ks])e(ial  eft\n-\  is  made 
fu  deiijousfiate  the  nse  of  the  Roentgen  Itay  in  diagnosis  l)y  in- 
slvnction  in  botli  lluoioseopy  and  plate  reading,  one  hour  a  week 
to  section  of  the  fonrtli  year  class  thronghont  the  yeai-. 

The  stndent  is  also  taught  the  practice,  aj»j>lication  of  Kadiuni 
and  Koenlgen  rays  as  therajieutic  agents.  In  the  X-ray  labora- 
tory and  in  the  hos]»ital  wards  students  are  shown  the  use  of  these 
ligeiHs  in  the  treatment  of  disease. 


DISEASES  OF  THE  THROAT  A>D  NOSE, 

1>1)\VAK1)  A.    LOOPKK.    ^I.D.. 

riinieal  Professor  of  Diseases  of  tbe  Throat  ami  Nose 
Fkank  Dyer  Sanger,  M.D.  . .  .Professor  of  Diseases  of  tlie  Tliroat  and  Nose 
(Jeorge  W.  Mitchell.  ^I.D.. 

Associate  Professor  of  Diseases  of  the  Tlu-oat  and  Nose 
(iiooRGE  MuRGATKovi),  M.D ....  Associate  in  Diseases  of  tbe  Throat  and  Nose 
Frank  Anderson.  M.D Assistant  in  Diseases  of  the  Throat  and  Nose 

TiHUD  Ykak.  Clinical  Lectures.  One  hour  each  week  ihrougli- 
our  the  session.    Drs.  Loopei-  and  Sanger. 

FoiUTH  Yi:ai!.  Disjjensary  instruction  daily  in  small  sections 
al  1h,e  T'niversity  and  ^fercy  Hospitals.  Ward  classes  one  hour 
e.uh  week  at  the  I'nivei-sity  and  Mercy  Hos])itals. 


GENITO-URINARY  DISEASES. 

.Vnton  (i.  Rytina,  A.B..  M.D I'rofessor  of  (ienito-I'rinary  Diseases 

I'AGE  Edmunds,  M.D Clinical  Professor  of  (Jenito-T'rinary  Diseases 

A.  .T.  I'NDERHiLL,  A.B..  M.D ..  Clinical  Professor  of  (Jenito-Trinary  Diseases 

IIarrls  (lOLDMAN Associate  in  Cenito-rrinary  Diseases 

A.  .7.  GiLLis.  M.D Instructor  in  (ienito-lrinary  Diseases 

W.  II.  ToTTLSON.  M.D Tnstrnctor  in  (ienito-rrinary  Diseases 

L.  K.  Fargo.  M.D Assistant  in  Oenito-Frinary  Diseases 


CLIXICAL    IXSTRUCTIOjS'  59 

Instruction  in  (Jenito  rrinarv  Suigery  is  given  to  tlie  members 
of  the  senior  class,  from  both  a  j)raetical  and  didactic  standfioint. 
The  course  includes  everything  pertaining  to  modern  urology. 
such  as  urethroscopy,  cystoscopy,  ureter  catheterization,  renal 
functional  tests,  X-ray,  pyelography,  blood  urea  estimations,  etc. 
The  teaching  consists  of  clinics  in  the  am^jhitheatre,  ward  rounds, 
and  attendance  by  members  of  the  senior  class  u}»on  out-patients 
in  the  dispensary.  In  the  latter  department  there  were  about 
r>0.t)(Ml  visits  nuuie  during  the  past  year,  and  ample  facilities  are 
afforded  the  students  to  see  a  large  variety  of  every  type  of 
venereal  disease.  They  are  first  instructed  in  the  method  of  tak- 
ing a  gen i to-urinary  history,  are  shown  the  technicpie  of  ure- 
throscopy, cystosfopy.  urethral  instrumentation,  rectal  massage, 
demonstratitais  of  the  spirochaete  pallida,  and  administration  of 
^alvarsan. 


DISEASES  OF  THE  COLON  AND  RECTUM. 

G.  Milton  Linthicum.  A.M..  M.D., 

Professor  of  Diseases  of  Rectum  and  Colon 

Charles  F.  Blakk.  M.D Professor  of  Diseases  of  Rectum  and  Colon 

J.  Dawson  Reedek.  M.D.. 

Associate  Professor  of  Diseases  of  Rectum  and  Colon 

ForcTH  Yr.AR.  This  course  is  for  instruction  in  diseases  of  the 
Colon,  Hligmoid  Flexure,  Rectum  and  Anus. 

One  lecture  a  week  throughout  the  first  semester  will  be  given 
in  the  Clinical  Amphitheater  of  the  Hospitals.  The  lecture  will 
cover  the  essential  features  of  the  Anatomy  and  Physiology  of  the 
large  intestine;  as  well  as  the  various  diseases  to  which  it  is  sub- 
ject. The  importance  of  diseased  conditions  and  malpositions  (»f 
the  intestines,  in  relation  to  systemic  disturl>ances.  will  be  empha- 
sized by  demonstrations. 

In  small  groups,  the  students  will  be  taken  into  the  wards  and 
dispensaries  of  the  University  and  Mercy  Hospitals,  where  differ- 
ent phases  of  the  various  diseases  will  be  taught  by  direct  obser- 
Ti'tion  and  examination.  The  use  of  the  proctosco]»e  and  sigmoi- 
dosco]»e  in  examination  of  the  rectum  and  sigmoid  will  l)e  made 
fainiliar  to  each  student. 

A  course'  in  Proctoscopy  may  be  given  in  the  City  Hospitals  at 
Bav  V'^ew.  where  abundance  of  material  is  always  obtainable 


60  CLINICAL,   INSTRUCTION 

DEPARTMENT  OF  MEDICINE. 

>» 

GoBDOX  Wilson,  M.D Professor  of  Medicine 

Gary  B.  Gamble,  Jr.,  A.M.,  M.D Professor  of  Medicine 

Sta^dish  McCleary,  M.D Professor  of  Clinical  Medicine 

Jos.  E.  GiCHNER,  M.D Professor  of  Clinical  Medicine 

Charles  W.  McElfresh,  M.D Professor  of  Clinical  Medicine 

G.  Carroll  Lockard,  M.D Professor  of  Clinical  Medicine 

Harvey'  G.  Beck,  M.D.,  Sc.D Professor  of  Clinical  Medicine 

Hubert  C.  Knapp,  M.D Associate  Professor  of  Medicine 

C.  C.  W.  JuDD,  A.B.,  M.D Associate  Professor  of  Medicine 

H.  D.  McCARTi',  M.D Associate  Professor  of  Medicine 

Wm.  H.  Smith,  M.D Associate  in  Clinical  Medicine 

R.  C.  Metzel,  M.D Associate  in  Clincial  Medicine 

W.  I.  Messick,  M.D Associate  in  Clinical.  Medicine 

E.  E.  Mayer,  M.D Instructor  in  Medicine 

George  McLean,  M.D Instructor  in  Medicine 

D.  Corbin  Streett,  M.D Instructor  in  Medicine 

C.  C.  Habliston,  M.D Instructor  in  Medicine 

Harry  M.  Stein Instructor  in  Medicine 

Martin  Sloan Instructor  in  Medicine 

Horace  Byers,  M.D Assistant  in  Medicine 

H.  R.  LicKLE,  M.D Assistant  in  Medicine 

Wm.  Michael,  M.D Assistant  in  Medicine 

G.  L.  Zimmerman,  M.D Assistant  in  Medicine 

B.  T.  Baggott,  M.D Assistant  in  Medicine 

J.  W.  Martindale,  M.D Assistant  in  Medicine 

CLINICAL  MEDICINE. 

Third  Year.  Lectures  and  recitations  on  the  principles  of 
medicine,  for  three  hours  a  week  throughout  the  session.  Clinical 
conference,  one  hour  each  week  throughout  the  session. 

Fourth  Year.  Lectures,  recitations  and  clinics  to  the  entire 
class  four  hours  a  week  throughout  the  session. 

A  clinical  pathological  conference  is  held  once  a  week  through- 
out the  session,  at  which  the  material  obtained  at  autopsy  is 
studied  in  relation  to  the  clinical  findings. 

The  whole  class,  divided  between  the  two  hospitals  and  again 
subdivided  into  small  groups,  receives  beside  instruction  twelve 
hours  a  week  throughout  the  session  and  has  the  care  of  the  hos- 
pital patients  under  the  direct  supervision  of  the  hospital  staff 
taking  all  histories,  making  the  ])hysical  examinations,  doing 
rcH]uisite  laboratory  tests,  following  and  recording  the  progress 
of  the  disease  in  the  individual  patient. 


CLINICAL    INSTRUCTION  61 

PHYSICAL  DIAGNOSIS. 

t^EOOXD  Year.  Didactic  lectures  and  practical  demoustrations 
in  the  medical  topograph}'  and  the  physical  conditions  in  health, 
preparatory  to  the  course  in  physical  diagnosis  in  the  third  year. 
Two  and  one-half  hours  each  week  during  one  semester. 

Third  Year.  The  class  is  divided  into  small  groups,  and  each 
section  receives  instruction  for  the  entire  session  in  the  medical 
dispensaries  of  the  hospitals.  During  the  second  semester  the 
students  under  the  supervision  of  instructors  examine  and  treat 
patients  in  the  medical  dispensaries.  During  one  semester  small 
groups  are  sent  for  the  afternoon  to  the  city  hospitals  at  Bay 
Mew  for  special  instruction  in  history  taking  and  physical  diag- 
nosis. Two  hours  a  week  throughout  the  year  are  devoted  to  phy- 
sical diagnosis.  Full  class  conferences  one  hour  a  week  through- 
out the  session. 

THERAPEUTICS. 

Third  Year.  This  course  is  supplementary  to  that  on  clinical 
medicine,  and  an  effort  is  made  to  familiarize  the  student  with 
the  practical  treatment  of  disease.  The  course  is  divided  into 
general  therapy,  specific  therapy  and  physical  therapy.  Two  and 
one-half  hours  per  week  throughout  the  year  is  devoted  to  these 
branches. 

Fourth  Y'ear.  Special  consideration  is  given  to  the  practical, 
application  of  therapeutic  principles  in  bedside  teaching. 

TUBERCULOSIS. 

A  practical  course  is  given  in  the  tuberculosis  dispensary  and 
at  the  Municipal  Tuberculosis  Hospital  to  small  groups,  the  abun- 
dance of  material,  both  of  "incipient"  and  ''advanced  cases," 
making  this  course  of  value  in  the  practical  recognition  of  the 
physical  signs  of  the  disease. 

GASTRO-ENTEROLOGY. 

Julius  Friedenwald,  A.M..  M.D Professor  of  Gastro-Eiiterology 

John  C.  Hemmeter,  M.D.,  Ph.D.,  f^c.D..  LL.D.Professor  of  Clinical  Medicine 

T.  Fred.  Leitz,  M.D Clinical  Professor  of  Gastro-Enterology 

E.  B.  Freeman,  B.S..  M.D Clinical  Professor  of  Gastro-Enterology 

J.  Harry  Ullrich,  M.D Associate  in  Gastro-Enterology 

Theodore  Morrison,  M.D Associate  in  Gastro-Enterologj- 

Maurice  Freeman.  M.D Instructor  in  Gastro-Enterology 

Joseph  Sindler.  M.D Assistant  in  Gastro-Enterologj- 


02  CLINICAL.   INSTRUCTION 

Fourth  Year,  Clinic  recitations  and  demonstrations  to  each 
half  of  the  class  for  one  hour  a  week  throughout  the  session.  Dis- 
pensary instruction  to  small  groups  throughout  the  en  fire  session. 
Practical  instruction  in  the  wards  in  the  differential  and  clinical 
<liagnosis  and  demonstrations  of  the  newer  methods  of  diagnosis 
in  gastrointestinal  aff'ections. 

PEDIATRICS. 

John  Ruhbah,  M.D I'rofessor  of  Pediatrics 

Charles  L.  Summers,  M.D Professor  of  Pediatrics 

Edgar  B.  Friedenwald.  M.D Clinical  Professor  of  Pediatrics 

C.  LoRiNG  JosLiN.  M.D Instructor  in  Pediatrics 

W.  H.  Ingram,  M.D Assistant  in  Pediatrics 

John  S.  Fenby,  M.D Assistant  in  Pediatrics 

J.  F.  Hawkins.  M.D Assistant  in  Pediatrics 

Howard  H.  Warner.  M.D Assistant  in  Pediatrics 

John  Houff.  M.D Assistant  in  Pediatrics 

B.  J.  Ferry,  M.D ." Assistant  in  Pediatrics 

Wn.LiAM  J.  Todd.  M.L> Assistant  in  Pediatrics 

Percy  P.  Hardt.  M.D Assistant  in  Pediatrics 

John  H.  Traband.  M.D Assistant  in  Pediatrics 

C.  K.  GoLDSBOROUGH.  M.D Assistant  in  Pediatrics 

Third  Year.^  Lectures  and  recitations  to  the  entire  class  one 
hour  weekly  throughout  the  year. 

Fourth  Year.  Lectures  and  recitations  one  hour  weekly  to  the 
entire  class.  Also  a  weekly  clinical  lecture  is  given  throughout  the 
year,  where  the  character  of  disease  is  fully  demonstrated  and 
the  students,  in  groups,  are  given  opportunity  for  personal  exami- 
nation of  cases. 

In  addition,  during  this  year  the  sfudeuts,  in  groups,  attend  the 
Children's  dispensary  daily,  and  are  here  given  the  opi)ortunity 
to  examine  all  cases  under  the  su[»ervision  of  competent  in- 
structors. 

NEUROLOGY. 

Irving  J.  Spear,  M.D Professor  of  Neurology 

.Vndrew  C.  Gillis,  A.m.,  M.D Professor  of  Neurology 

G.  M.  Settle.  A.B.,  M.D .Associate  Professor  of  Neurology 

Ben.iamin  Pushkin,  M.D Instructor  in  Neurology 

J.  A.  Skladowsky,  M.D Assistaait  in  Neurology 

Third  Y'ear.  Lectures  and  recitations  two  hours  each  week  to 
entire  class  throughout  one  semester.     This  course  com}»rises  the 


CLINICAL    INSTRUCTION  6^3 

study  of  the  anatomy  and  [»hysiology  of  the  nervous  system,  the 
method  of  neuiological  examination,  and  ielati(>nshi]t  of  signs 
and  symptoms  to  pathological  conditions.  The  material  at  the 
Univei-sity  and  Mercy  Hospitals  is  available. 

Fourth  Year.  Clinical  lectures  and  recitations,  one  hour  each 
week  throughout  the  entire  session. 

Clinical  Conference,  one  hour  each  week  to  the  entire  class. 
This  subject  is  taught  at  the  University  and  Mercy  Hospitals.  All 
cases  pi-esented  at  these  clinics  are  carefully  examined;  complete 
written  records  are  made  by  the  students  who  demonstrate  the 
cases  before  the  class.  These  cases  are  usually  assigned  one  or 
two  weeks  before  they  are  presented,  and  each  student  in  the 
class  must  ]jre])are  one  or  more  cases  during  the  yeai-. 

WaifJ  r/u.y.s  I ii.stniction.  In  small  sections,  two  hours  eadi 
week  duiing  the  entire  year  at  the  Cni versify  and  Mercy  Hos- 
pitals. In  these  classes  the  students  come  in  close  personal  con- 
tact with  the  cases  in  the  wards  under  the  supervision  of  the  in- 
structor. 

Disi)(nfi(ii If  I ni^iruciion.  Small  sections  are  instructed  in  the 
dis})ensaries  of  the  University  and  Mercy  Hospitals  four  after- 
noons each  week.  In  this  way  students  are  brought  into  cimtact 
with  nervous  diseases  in  their  earlier  as  well  as  later  manifesta- 
tions. 

Electro  Therapeutics.     Instruction  in  the  uses  of  the  various 
types  of  electrical  apparatus  is  given  by  lectures  and  demonstra 
tions  in  the  clinics,  the  ward  classes,  and  the  out-patient  dc^part- 
ment. 

PSYCHIATRY. 

R.  M.  Chapman.  M.D Associate  Professor  of  Phychiatry 

(J.  F.  Sargf:nt.  M.D Associate  in  Clinical  Psychiatry 

FoT  KTH  VKAit.  This  subject  is  taught  by  means  of  didactic  and 
clinical  lectures.  Abundant  material  is  at  the  command  of  this 
<lei)artment  in  the  various  institutions  which  are  jtresided  over 
l)y  the  teachers  in  psychiatry.  The  student  is  brought  into  con- 
tact with  the  early  manifestations  of  mental  disease  in  the  dis- 
jiensaries  of  the  University  and  Mercy  Hospitals,  and  in  a  series 
of  clinics  opportunity  is  afforded  to  observe  the  course  and  later 
manifestations  of  the  disease,  often  in  these  same  patients,  at  the 
Sheppard-Knoch  Pratt  Hos])ital,  Mount  Hope  Retreat,  and  City 
Detention  Hospital. 


64  CLINICAL    INSTRUCTION 

HYGIENE  AND  PREVENTIVE  MEDICINE. 

C.  Hampson  Jones,  M.D.,  CM Professor  of  Hygieue  aud  Public  Healtti 

Third  and  Fourth  Years.  In  each  year  one  lecture  every  week 
to  the  entire  class  throughout  the  session.  A  quiz  will  be  sub 
stituted  for  a  lecture  whenever  it  is  considered  advantageous  to 
do  so.  The  lectures  to  the  third  year  class  will  encompass  all  of 
The  fundamental  subjects,  air,  water,  soil,  food,  disposal  of  wastes, 
etc..  leading  to  the  fourth  year,  when  communicable  diseases  of 
all  kinds  will  be  considered  in  groups  and  singly.  State  and 
Federal  laws  to  promote  and  protect  public  health  will  be  con- 
sidered during  the  presentation  of  groups  of  diseases. 

DEPARTMENT  OF  OBSTETRICS. 

J.  M.  H.  Rowland,  M.D Professor  of  Obstetrics 

L.  E.  'Skale,  A.m.,  M.D.,  LL.D Professor  of  Obstetrics 

Bernard  Purcell  Muse,  M.D Professor  of  Clinical  Obstetrics 

Charles  E.  Brack.  M.D Clinical  Professor  of  Obstetrics 

J.  McF.  Bergland Associate  in  Obstetrics 

L.  H.  Douglass,  M.D Associate  iu  Obstetrics 

F.  H.  Machin,  M.D Assistant  In  Obsterics 

J.  G.  M.  Reese,  M.D Assistant  in  Obstetrics 

SusANNE  R.  Parsons,  A.M.,  M.D.,  Ph.D Assistant  in  Obstetrics 

Third  Year.  Lectures  and  recitations  two  hours  each  week  by 
Drs.  Neale  and  Rowland  to  entire  class.  Special  obstetric  and 
gynecologic  pathology  three  hours  each  week  under  the  direction 
of  Dr.  Gardner  to  class  sections  in  the  Pathologic  Laboratory. 
Clinical  Obstetrics  (bedside  and  manikin  work)  three  hours  each 
week  at  the  University  Hospital  by  Dr.  Neale  and  his  assistants, 
and  at  the  Mercy  Hospital  by  Dr.  Brack. 

Examinations,  one  at  the  end  of  .first  semester  and  final  one  at 
end  of  the  year.  The  results  of  these  examinations,  considered  in 
conjunction  with  the  student's  practical  work,  will  determine  the 
grade  for  the  year's  work,  which  grades,  if  sufficient  to  give  stu- 
dent advanced  standing,  will  count  as  one-half  of  the  final  grade 
in  Obstetrics. 

Fourth  Year.  Lectures  and  Clinical  Conferences.  Two  hours 
each  week  to  the  entire  class.    Drs.  Neale  and  Rowland. 

Ward  Classes  and  Operative  Obstetrics  (Manikin  work).  Four 
hours  each  week  to  sections  of  the  class.    Dr.  Douglass. 

Students  are  required  to  attend  obstetric  cases  before,  during 
and  after  confinement  in  the  University  Hospital,  as  well  as  in 


CLINICAL    INSTRUCTION  65 

the  out-patient  department.  Each  student  is  required  to  conduct 
and  make  accurate  records  of  at  least  twelve  confinement  cases. 
These  out-patient  cases  are  conducted  under  the  supervision  of 
post-graduate  instructors,  two  in  number,  who  devote  their  whole 
rime  to  this  work. 

Mid-year  and  final  examinations  will  be  held,  the  results  of 
which,  considered  in  conjunction  with  clinical  work  and  recita- 
tions, wdll  make  up  the  remaining  half  of  the  final  grade. 

This  School  is  peculiarly  fortunate  in  the  clinical  material 
available  for  this  important  branch  of  medical  teaching;  1,250 
cases  in  the  hospital  and  out-patient  department  make  a  prac- 
tical inexhaustible  clinic. 


DEPARTMENT  OF  GYNECOLOGY. 

William  S.  Gardner.  M.D Professor  of  Gynecology 

J.  Mason  Hundley,  M.D Professor  of  Clinical  Gynecology 

HrcH  Brent,  M.D Associate  Professor  of  Gynecology 

Abraham  Samuels,  M.D Associate  Professor  of  Gynecology 

Geo.  A.  Strauss,  M.D Associate  in  Gynecologj" 

R.  G.  WiLLSE,  M.D Associate  in  Gynecology 

T.  K.  Galvin,  M.D Assistant  in  Gynecology 

Jack  M.  Hundley,  M.D Assistant  in  Gynecology 

Third  Year.  Didactic  Work.  A  course  of  twenty  lectures  and 
recitations  in  the  second  semester.     Dr.  Hundley. 

Lahoratorij.  Special  pathology,  both  gross  and  microscopical, 
studied  in  connection  with  the  clinical  history  of  each  patient 
from  which  the  specimen  was  derived,  two  hours  each  week  dur- 
ing the  first  semester.  Drs.  Gardner,  Strauss,  Samuels,  Brent, 
Galvin  and  Jack  M.  Hundley. 

Fourth  Year.  Didactic  Work.  Lectures  and  recitations,  one 
hour  each  week  throughout  the  session.    Dr.  Gardner. 

Clinical  Work.  Six  hours  weekly  for  one  trimester.  In  this 
course  a  student  writes  the  clinical  history  of  each  patient  in  the 
ward,  makes  a  general  physical  examination,  including  the  blood 
and  urine,  before  the  patient  is  brought  before  the  class.  One 
student  under  supervision  gives  the  anesthetic,  a  pelvic  examina- 
tion is  made  by  six  students,  and  any  operation  required  is  then 
done  before  a  section  of  the  class  small  enough  to  see  clearly  what 
is  being  done  and  how  it  is  done.  On  a  subsequent  day  the  whole 
group  examine  microscopically  sections  prepared  from  material 
removed  from  patients  that  have  been  before  them. 


66  CLINICAL   liSTSTEUGTlON 

DEPART3IE1NT  OF  OPHTHALMOLOGY  AND  OTOLOGY. 

Harry  Fru;denwalo.  A.B..  M.D. .  .Professor  of  Uiilitlialniology  and  Otology 

J.  \V.  Downey,  M.I  > ( 'liuical  I'rofessor  of  Otology 

Clyde  A.  Clapp,  M.D.  . .  .Associate  Professor  ttf  Ophtluiliiiology  and  Otology 

H.  K.  Fleck,  M.D Associate  in  Opbtbainiology  and  Otology 

Joseph  I.  Kemler,  M.D Associate  in  Opbtlialnmlogy  and  Otology 

M.  Randolph  Kahn,  M.D Associate  in  <  >i)litlialniology  and  Otology 

K.  A.  Knorr.  M.D Associate  in  Oiilitlialniology  and  Otology 

Thirl*  Year.  Course  in  Refraction  and  in  the  llitcrnal  Dis- 
eases of  the  Ei/e.  ouce  weekly,  October  to  Decemltev.     Di-.  Clapp. 

Voarses  in  the  Diseases  of  the  Ear,  twice  weekly,  October  to 
December.    Dr.  Downey. 

Practical  Courses  in  OphtJiahnoseopij,  once  weekly,  in  secticms. 
]hs.  Fleck  and  Kemler. 

Fourth  Year.  Course  in  Diseases  of  the  J'Ji/e.  once  weekly 
(hiring  year.    Dr.  Harry  Friedenwald. 

Clinics  in  Diseases  of  the  Eye  and  the  Ear,  weekly.  Drs.  Harry 
Friedenwald  and  Downey. 

lUspensarii  Instruction,  elective  course  daily  in  small  sections. 

The  courses  in  Ophthalmology  and  Otology  are  designed  to 
familiarize  the  students  with  the  common  diseases  of  the  eye  and 
ear,  their  recognition  and  treatment,  with  a  view  to  meet  the 
needs  of  the  general  practitioner.  Special  emphasis  is  laid  uiK»n 
the  relation  between  diseases  of  the  eye  and  the  ear  and  syste- 
matic diseases  of  other  organs. 

LABORATOKIES  OF  CLINICAL  PATHOLOGY. 

John  Lutz.  M.D Associate  Professor  of  Clinical  Pathology 

Henry  L.  Collenberg,  M.D Associate  in  Clinical  Pathology 

I..  A.  M.  Krax:s.  M.D Assistant  in  Clinical  Pathology 

During  the  third  year  the  student  is  tluu'oughly  drilled  in  the 
technique  of  the  usual  clinical  laboratory  work,  so  that  he  is  able 
(o  j)erform  all  routine  examination  which  may  be  called  for  dur- 
ing his  fourth  year,  in  connection  with  the  work  in  the  wards  and 
dispensary.  In  addition  he  is  trained  to  do  bacteriological  and 
serological  work  as  will  fit  him  to  occupy  an  assistant's  position 
in  a  civil  hosjjital  laboiatory  where  modern  public  healtli  and 
epidemiological  work  is  carried  <tu. 

The  practical  W(»rk  is  supplemented  by  a  series  of  didactic  lac- 
tui-es   and  demonstrations  in  which  the  eutire  teaching  statf  of 


CLINICAL    IXSTEUCTION  67 

the  depaitinent  takes  an  active  part.  The  inicio.scopieal,  ebein- 
ical,  baetei-iological  and  serological  study  of  blood,  exudates  and 
transudates,  gastric  juice,  feces  and  urine  are  successively  taken 
up,  and  special  attention  directed  to  the  clinical  significance  of 
the  findings. 

Clinical  jjarasitology  and  advanced  bacteriology,  both  froui  the 
standpoint  of  the  infecting  agent  and  the  carrier,  are  given  care- 
ful consideration. 

The  entire  course  is  thoroughly  practical.  Each  student  is  pro- 
vided with  a  niici-oscope,  blood  counters  and  hemoglobin<^»niete]- 
for  his  exclusive  use,  and  every  two  students  with  a  special  labor- 
atory outfit  for  all  routine  purposes. 

During  the  fourth  year  the  student  applies  what  he  has  learned 
during  the  ]U'eceding  year  in  the  laboratories  of  the  various  attili 
ated  hos]ji1a]s.  He  is  also  supplied  with  a  laboratory  outfit  which 
is  sufficiently  complete  to  enable  him  to  work  independently  of 
the  general  equipment.  Special  instructors  are  available  during 
ceitain  hours  to  give  necessarv  assistance  and  advice. 


68 


SCHEDULE 


FIRST   YEAR    SCHEDULE — FIRST   SEMESTER. 


Hours. 

Monday. 

Tuesday. 

"Wednesday 

Thursday. 

Friday. 

Saturday. 

A.  M. 

9  to  10. 

10  to  11. 

Histology  and  Embryology  Laboratory. 

r                                              1                                               ( 

Bacteriology 

Embryology. 

Dissecting. 

11  to  12. 

Physiology. 

Histology.     I    Physiology. 

Histology. 

Physiology. 

P.  M. 

12  to  1. 

Lunch   and   Transfer  Period. 

1  to  4. 

Anatomy                               and                               Dissecting. 

Classes    in   Anatomy   and   Dissecting   at   Lombard   and    Greene    Streets ;    all   other   classes   at 
.Streets :   all  other  classes  at  Calvert  and  Saratoga  Streets. 


FIRST   YEAR   SCHEDULE— SECOND    SEMESTER. 


Hours. 

Monday. 

Tuesday. 

Wednesday 

Thursday. 

Friday. 

Saturday. 

A.  M. 

8.30  to 
9.30. 

Histology  and  Embryology  Laboratory. 

Bacteriology 

9.30  to 
10.30. 

Embryology. 

Dissecting. 

10.30  to 
11.30. 

Physiology.          Histology 

Physiology. 

Preliminary 

Physiological 

Chemstry. 

Physiology. 

11.30  to 
12.00. 

Lunch. 

Immunology 

P.  M. 
12  to  2. 


Bacteriology. 


Laboratory. 


and  Serology 

(11.30-    to 

12.30). 


2  to  2.30. 


2.30  to 
5.30. 


Transfer  Period. 


Anatomy 


and 


Dissecting. 


Classes  in  Anatomy  and  Dissecting,   and  in  Immunology  and  Serology  at  Lombard  and  Green*, 
•Calvert  and  Saratoga"  Streets. 


SCHEDULE 


69 


SECOND  YEAR  SCHEDULE— FIRST  SEMESTER. 


Hours. 

Monday. 

Tuesday. 

Wednesday.        Thursday. 

Friday. 

Saturday. 

A.  M. 

8.30  to 

9.30. 

Physiology. 

Laboratory : 
Physiology. 
Section  A. 
Physiological 
Chemistry, 
Section  B. 

Physiology. 

Laboratory : 
Physiology, 
Section  B. 
Physiological 
Chemistry, 
Section  A. 

Physiology. 

9.30  to 
10.30. 

Physiological 
Chemistry. 

Physiological 
Chemistry. 

Physiological 
Chemistry. 

Pharmacology 

10.30  to 
11.30. 

Pathology. 

Pharmacology 

Pathology. 

Pathology. 

11.30  to 
12.30. 

Pharmacology 

Lunch  and  Transfer  Period. 

Immunology 
and   Serology. 

12.30  to             Lunch. 
1.30.       ' 

Immunology 
and    Serology 

Laboratory. 

Immunology 
and  Serology 

Laboratory. 

Surgery.             Surgery. 

1.30   to 
2.30. 

Pharmacology 
Laboratory. 

Medicine. 

Medicine. 

2.30  to 
3.30. 

Surgical 
Anatomy. 

Surgical 
Anatomy. 

3.30  to 
4.30.      ; 

Surgical 
Anatomy. 

Surgical 
Anatomy. 

4.30   to 
3.30 

Classes  on  Tuesdays,  Wednesdays,  Thursdays  and  Fridays  from  12.30   to  5.30,   at  Calvert  and 
Saratoga  Streets ;  all  other  classes  at  Lombard  and  Greene  Streets. 


SECOND   YEAR   SCHEDULE— SECOND    SEMESTER. 


A.  M. 

8.30  to 

9.30. 


Physiology. 


9.30  to 
10.30. 


10.30  to 
11.30. 


11.30  to 
12.00. 


P.  M. 

12  to  2. 


Physiological 
Chemistry. 


Pathology. 


Laboratory : 
Physiology, 
Section  A. 
Physiological 
Chemistry, 
Section   B. 


Physiology.    !  , 

I  Laboratory: 

• 1  Physiology, 

Physiological  Section  B. 

Chemstry.     j  Physiological 

j  Chemistry, 

_,               ,        !  Section  A. 
Pharmacology  I 


Pharmacology 


Physiological 
Chemstry. 


Pathology. 


Lunch. 


Pathology. 


Laboratory. 


2.00 

to 

5.00. 


Laboratory: 

Pharmacology 

Section  A. 

Physiological 
Chemistry, 
Secton    B. 


Laboratory: 
Pharmacology 
Section   A. 
Physiology, 
.'^ect'on   B. 


I    ^    ,  I    Laboratory . 

1    Laboratory:     pharmacology 
j  Pharmacology!     Section    B. 
Electives.      ,     Section    B.    j   Physiological 
Physiology,    |     Chemistry. 
I     Section   A.     !     Section   A. 


Physiology. 


Pharmacology 


Pathology. 


Medicine 
(11.30  to 
12.30). 


All  classes  at  Lombard  and  Greene  Streets. 


SCHEDULE 


THIRD   YEAR    SCHEDULE. 


Hours. 

Monday. 

Tuesday. 

Wednesday 

Thursday. 

Friday. 

Saturday. 

A.  M.     [ 

8.30  to 

Medicine. 

Pathology. 

Therapeutics. 

Surgery. 

Pathology. 

Surgery. 

9.30. 

9.30   to 

10.30 

Pediatrics. 

Surgery. 

Obstetrics. 

Medicine. 

Therapeutics. 

Medicine. 

Pliy.sical. 

Physical 

Physical 

Physical 

Physical 

Physical 

:jia.^no8is. 

Diagnosis. 

Diagnosis. 

Diagnosis. 

Diagnosis 

Diagnosis 

10.30. 



1 

Ojierative 

Operative 

Operative 

Operative 

Operative 

Operative 

to 

Surgery. 

Surgery. 

Surgery. 

Surgery. 

Surgery. 

Surgery. 

1.30. 

1  ispensary. 

Dispensary. 

Dispensary. 

Dispensary. 

Dispensary. 

Dispensary. 

; 

Lunch  and 

Lunch   and 

Lunch   and 

Lunch  and 

Lunch  and 

Luncli   and 

; 

'i'ransfer 

Transfer. 

Transler. 

Transfer. 

Transfer. 

Transfer. 

Neurology. 

p.  M. 

(first 

1.30 

semester). 

Neurology 

to 

Medical 

Otistetrics. 



3bstetrics 

(first   sem- 

•2.30. 

Clinic. 

Gynecology 

(second 
semester) . 

ester). 

Gynecology 
Laboratory 

2.30 

(second 
semester) . 

Clinical 

to 

Pathology 

Pathology. 

Legal 

Clinical 

Clinical 

Medicine 

3.30. 

Medicine 

(first 
semester) . 

and 

Pathology 

Pathology 

Gvnecology 

Gross   Pa- 

3.30 

L.i.boratory 
(second 

thology    at 

to 

semester) . 

1 

Laboratory 

Laboratory. 

Laboratory 

Laboratory 

Bav   View. 

4.30 

i    Anaesthesia 

(first 
1     semester). 

i 

Eye    and    I 

'ar — October 

3    to    December 

4.30 

21.      (Exami 

nation.  Decern! 

er  21.) 

Practical 

Physical 

Therapeutics — 

January    9     to 

Physical 

Obstetrics 

to 

February  15. 

(Examination 

.  February  15.) 

Diagnosis 

Nose  and  ' 

rhroat — Febru 

iry  20  to  Apri 

1 

Ophthalmos- 

,   5.30. 

25.       (Exami 

nation,   April  2 

5.) 

copy 

. 

From  10.30  A.  M.  to  1.30  P.  M.  the  class  is  divided  into  two  sections,  one  section  reporting 
at    Calvert  and    Saratoga    Streets,   the  other  at   Lombard  and  Greene  Streets. 

Classes  on  Wednesdays.  Thursdays  and   Fridays   from  1.30  to  5.30  at  Calvert  and  Saratoga  Sts. 

Proctology — Wednesdays  and  Fridays,  1.30  to  2.30,  for  ten  lectures,  April  11  to  May  12. 
inclusive. 


SCHEDULE 


71 


FOUETH  YEAR   SCHEDULE. 


Hours.           Monday. 

Tuesday. 

Wednesday 

Thursday. 

Friday. 

Saturday. 

Ward    Classes 
A.  M.     i 
9.00      1  Medicine, 

to        1  Surgery, 
11.00.     1  Obstetrics. 

Ward    Classes 

Medicine, 

Surgery, 

Gynecology. 

WdTiX    Classes 
Medicine, 
Obstetrics. 
X-Ray.  9-10. 
Surgery,   10- 
11. 

Ward    Classes 

.Medicine, 

Surgery 

Gynecology. 

Ward    Classes 

Medicine, 

Surgery. 

Proctology, 

Ward    Classes 

Medicine, 

Surgery, 

Gynecology. 

1100         Orthopedic 
1200.     '       S»i-gery. 

1 

Medical 

Clinic 

(University) 

Surgical 

Path. 
(Mercy) 

Clinical               Surgical 
Pithological            Clinic. 
Conference,    i 

Medical 
Clinic. 

Pediatrics 
Clinic. 

P.  M. 

12  00          Dispensary 
to             Lunch  and 
2.00.      '       Transfer 

!)isi)ensary 

and 

Luni-h 

Dispensary 

and  Lunch 

and  Transfer 

Dispensary 

and 

Lunch 

Dispensary 

and 

Lunch 

Dispensary 

and 

Lunch 

o  nn         I>ei7ma'tology 
2;00      1          Clinic 
J°        !(Full  class  at 
•'■0°-      ,  Univ.  Hosp.) 

Neurology 
Clinic  ■ 

Eye  and  Ear 

Clinic 
Full  class  at 
I'liiv.    Hosp. 

Genito-Uri- 
nary    Clinic 

Gastro- 
Enterology 
Clnic 

Psychiatry 
Clinic 

3.00   to 

?,.?.o. 

j 
Transfer,      i 

Transfer. 

Transfer. 

.3.30   to         „   ,.       . 
4.30.          Pediatrics. 

1 
Surgery.       1     Obstetrics. 

Surgery. 

Neurology. 

1 

4.30  to 
5.30.      j      Medicine. 

Eye. 

Medicine. 

Gynecology. 

Hygiene     and 

Prev. 

Medicine. 

The  Senior  class  is  divided  into  two  sections,  ^yhich  report,  one  at  Lombard  and  Greene 
Streets,  the  other  two  at  Calvert  and  Saratoga  Streets,  for  one  semester  each,  then  rotate  at  the 
end  of  tlie  first  semester  on  January  28,   1922, 

Each  section  of  the  class  is  divided  into  three  groups — Medical,  Surgical  and  Special,  These 
groups  will  rotate  on  the  following  dates : 

FIRST   SEMESTER.  SECOND    SEMESTER. 

1st   period,  Oct.      3  to  Nov.     5.  1st   period,  Jan.    30  to  Mch.     4. 

2nd  period.  Nov.     7  to  Dec.  10.  2nd  period,  Mch.    6  to  Apr.      8. 

3rd  period,  Dec.     12  to  Jan.  28.  3rd  period,  Apr.    10  to  May  13. 

The  schedules  are  identical  for  liotli  sections,  except  as  noted  on  Mondays,  from  2  to  3  P  M., 
and   on  Tuesdays  from   11   A.  M.   to  12   noon. 

All  lectures  from  3.30   to  5.30  P.  M.  are  to  be  attended  at  Lomtiard  and  Greene  Streets 


72  TRAINING  SCHOOL  FOR  NURSES 

THE  UNIVERSITY  HOSPITAL  TRAINING  SCHOOL  FOR 

NURSES. 

Miss  Lucy  Ann  Marshall,  SupeHntendent  of  Training  School. 

The  University  of  Maryland  School  for  Nurses,  established  in 
the  year  1889  for  the  purpose  of  instructing  women  in  the  art  of 
earing  for  the  sick,  is  now  entering  its  thirty-second  year. 

The  University  Hospital  is  a  large  general  hospital  containing 
about  250  beds,  and  is  equipped  to  give  young  women  a  thorough 
course  of  instruction  and  practice  in  all  phases  of  nursing  work. 

Unusual  advantages  are  offered  to  student  nurses  because  of 
the  varied  services  and  well-thought-out  curriculum,  taught  by 
qualified  instructors  and  members  of  the  Medical  Stafif  of  the  Uni- 
versity. 

The  Nurses'  Home,  while  not  a  new  building,  has  been  recently 
renovated  and  is  comfortable  and  cheerful. 

Candidates  wishing  to  obtain  the  course  of  instruction  must 
apply  personally  or  by  letter  to  the  Superintendent  of  Nurses. 
Those  applying  by  letter  should  enclose  a  statement  from  a  clergy- 
man testifying  to  good  moral  character,  and  one  from  a  physician 
certifying  to  sound  health  and  unimpaired  faculties.  No  candi- 
date will  be  considered  who  is  not  physically  fit.  Applicants  must 
not  be  under  19  or  over  35  years  of  age.  They  must  show  that 
they  have  graduated  from  a  high  school  or  have  the  equivalent  of 
such  a  degree  of  education.  The  Superintendent  of  Nurses  de- 
cides as  to  the  fitness  of  the  candidate  for  the  work  and  the  pro- 
priety of  dismissing  or  retaining  them  at  the  end  of  their  pro- 
bation term.  She  may  also,  with  the  approval  of  the  Committee, 
dismiss  a  pupil  from  the  school  at  any  time  for  misconduct  or 
inefficiency. 

The  course  of  instruction  covers  a  period  of  three  j'ears. 

Classes  are  admitted  in  February  and  March  and  September. 
Student  Nurses  are  on  duty  eight  hours  during  the  day,  and  ten 
hours  w^hen  on  night  duty,  except  during  the  first  six  weeks  of 
the  preliminary  period,  when  four  hours  are  spent  in  the  wards 
and  four  hours  in  the  classroom. 

When  the  work  will  permit  a  half  day  is  allowed  on  Sunday. 
The  term  of  night  duty  is  two  months  during  each  year. 

Sickness:  Pupils  when  ill  will  be  cared  for  gratutiously.  All 
time   lost  for  sickness  or  any   other  cause   must  be  made  up. 


TRAINING  SCHOOL  FOR  NURSES  73 

Should  the  authorities  of  the  school  decide  that  through  the  time 
lost  the  theoretical  work  has  not  been  sufficiently  covered  to  per 
mit  the  student  to  continue  in  that  year,  it  will  be  necessary  for 
her  to  continue  her  work  with  the  next  class. 

Allowances :  Students  are  allowed  flO.OO  each  month,  after  the 
first  three  months,  to  defray  the  expenses  incidental  to  her  train- 
ing, uniforms,  etc.  Students  receive  lodging,  board  and  a  rea- 
sonable amount  of  laundry  work  from  date  of  entrance.  Stu- 
dents receive  flS.OO  per  month  during  their  second  year  and- 
.|20.00  per  month  during  their  senior  year.  Sufficient  books  for 
students'  use  are  supplied  by  the  hospital. 

Vacations :  ^'acations  are  given  between  June  and  September. 
A  period  of  three  weeks  is  allowed  the  student  after  the  comple- 
tion of  the  first  and  second  years. 

Examinations :  Examinations  are  held  after  each  course  of 
study  and  lectures,  and  the  standing  of  the  student  at  the  end 
of  the  year  is  based  upon  the  results  of  these  examinations  and 
the  general  character  of  the  work  throughout  the  year. 

The  diploma  of  the  school  will  be  awarded  to  those  who  have 
satisfactorily  completed  the  full  term  of  three  years  and  have 
passed  successfully  the  final  examinations. 


Graduates  University  Hospital,  Class  1921. 
Student  Address 

Mary   Belle  McDaniel Maryland 

Susan   Paulino   Neady Pennsylvania 

Christine    Minnis Pennsylvania 

Zadieth  Violet  Reese Maryland 

Buby  Lee  Roister North  Carolina 

Claribel  Hampton North  Carolina 

Anna  Elizabeth  Woods Maryland 

Jessie  Geraldine  Rhodes , North   Carolina 

Louise  Lee   Bateman Maryland 

Kate  Womack  Hogshead North  Carolina 

Mary  Cutter  Fisher . Maryland 

Norma   Lavada   Gaver Maryland 

Ruth   Elizabeth    Gorman Maryland 

Helen  Eugenie   Reamy Virginia 

Helen  Margaret  Childs Maryland 

Blanche  Lee  Martin North  Carolina 

Isabelle  Jean  Hanna Maryland 

Julia    Rebecca    Smith Maryland 


74  THE  MEECY  HOSPITAL  TRAINING  SCHOOL  FOR  NURSES 

THE  MERCY  HOSPITAL  TEAINING  SCHOOL  FOR  NURSES. 

The  Mercy  Hospital  Training  School  for  Nurses,  conducted  by 
the  Sisters  of  Mercy  and  connected  with  the  College  of  Physicians 
and  Surgeons,  was  organized  and  incorporated  under  the  general 
laws  of  the  State  of  Maryland  in  1899.  Its  first  students  were 
graduated  in  1901 ;  and  on  the  passage  of  the  bill  for  registration 
in  1904  the  Sisters  of  Mercy,  connected  with  the  Hospital  serv- 
ice, received  certificates  as  registered  nurses. 

The  Training  School  was  affiliated  with  the  Board  of  Regents 
of  the  State  of  New  York  in  1906;  and  in  the  same  year  the 
Alumnae  Association  was  incorporated,  having  been  previously 
connected  with  the  Associated  Alumnae  of  the  United  States. 
The  graduates,  as  active  members,  have  been  much  interested  in 
the  movements  of  the  Maryland  Association  of  Graduate  Nurses, 
to  whom  they  have  given  every  encouragement  to  uplift  the  pro- 
fession in  its  many  works  of  district  nursing,  tuberculosis  cam- 
paign. Red  Cross  movements,  etc. 

The  requirements  for  entrance  are:  Highest  moral  standing, 
health,  intelligence  and  a  High  School  education  or  Us  equivalent. 
The  age  limit  is-  twenty  to  thirty-five  years. 

After  a  three  months'  probation,  candidates,  if  they  possess  the 
necessary  qualifications,  are  admitted  to  the  Training  School 
proper,  receiving  five  dollars  a  month  wherewith  to  secure  text- 
books, etc.,  the  education  they  receive  being  considered  their 
compensation.  The  right  is  reserved  to  dismiss  pupils  for  any 
cause  which  may  be  deemed  sufficient  by  the  Sister  Superior  or 
Superintendent. 

The  course  of  training  comprises  three  years  of  theory  and 
]»ractice.  The  clinical  advantages  are  exceptional.  The  medical, 
surgical,  orthopedic,  gynecological,  obstetrical,  children's  and 
dietetic  departments  give  valuable  practical  experience.  The 
nurses  are  taught  the  theory  of  nursing  by  class  recitations  and 
demonstrations  by  efficient  Sister  instructors.  Supplementing 
this  training  is  a  course  of  lectures  from  the  professors  of  the 
University  of  Maryland  School  of  Medicine  and  College  of  Phy- 
sicians and  Surgeons,  who  are  untiring  in  their  efforts  to  keep 
the  School  abreast  with  modern  scientific  developments. 

Graduates,    1921. 
Name  Address 

Sister  Mary  Consilia Arkansas 

Anne  Marie  Baker West  Virginia 

Katherine   Ann   Blickenstaff Maryland 

Dorothy  Mae   Chenoweth Maryland 


EasnOWMENT   FUND  75 

Ella     Clatterbuck Pennsylvania 

Sabina  P.  Concannon Maryland 

Eachael     Darby Pennsylvania 

Kathryn  Marie  Cowling Pennsylvania 

Mary  Agnes  Dunnigan Maryland 

Frances   Esther   Hatfield Maryland 

Beatrice    Frances    Hilton Pennsylvania 

Mary   Adeline   Hoffnagle Pennsylvania 

Mary  Genevieve  Keef er Pennsylvania 

Anna   Catherine    Lavell Massachusetts 

Buth    Woodring    Lykens '. Pennsylvania 

Mary  Virginia  McKay Maryland 

Martha  Evelyn  Newman Maryland 

Henrietta  Marie   O '  Flynn New   York 

Elizabeth  Marie   Oswald Pennsylvania 

Mary  Helen  Bathbone West  Virginia 

Georgie  Cecelia  Eeid Maryland 

Eileen   Ann    Bice Pennsylvania 

Agnes  Eleanor  Byan West  Virginia 

Isabelle   Schultz West  Virginia 

Billie  A.  Sharpe West  Virginia 

Lexavae    Stanley West    Virginia 

Buth    Ellen    Stigers Maryland 

Nathalie    E.    Vetra Maryland 

Maude  Cecelia  Walbert Maryland 

Horace   A.    Wilson Maryland 


ENDOWMENT  FUND. 

The  following,   all  Alumni  of  the   University,   constitute  the 
Board  of  Trustees  of  this  Fund : 

Hon.  Heney  8tockbridge,  LL.D.  .Stuart  S.  Janney,  Esq. 

Harry  Adler,  M.D.  John  B.  Thomas,  Ph.G. 

Charles  Maekell,  LL.B.  B.  Merrill  Hopkinson,  M.D. 

Arthur  M.  Shipley,  M.D. 

This  Board  is  incorporated  by  act  of  the  Legislature  of  the 
State,  its  legal  title  being  *'The  Trustees  of  the  Endowment  Fund 
of  the  University  of  Maryland,"  and  is  independent  and  self-per- 
petuating, filling  itself  any  vacancies.  Its  powers  are  limited  to 
the  expenditure  of  the  interest  derived  from  the  fund,  which  is 
to  be  applied  in  the  discretion  of  the  Board  for  the  benefit  of  the 
University.  Contributions,  donations  and  bequests  are  solocited 
from  Alumni  and  friends.  They  may  be  made  to  the  general  or 
University  Fund,  to  the  Medical  Fund  or  to  any  other  department 
of  the  University.  If  intended  for  the  School  of  Medicine,  they 
may  be  given  to  the  general  medical  fund  or  to  some  special  ob- 
ject, as  building,  research,  library,  pathology,  hospital,  publica 
tion,  laboratories,  gymnasium,  scholarship,  medal,  prize,  etc.,  in 


76  FORMS  OF  DEVISE  OR  BEQUEST 

which  case  the  wishes  of  the  donor  will  be  strictly  regarded.  At- 
tention is  invited  to  the  ''Charles  Frick'Kesearch  Fund,"  already 
established  in  memory  of  that  distinguished  investigator.  Checks 
should  be  made  payable  to  B.  Merrill  Hopkinson,  M.D..  Treasurer. 
Professional  Building,  Baltimore,  Md. 


FORMS  OF  DEVISE  OR  BEQUEST. 

To  School  of  Medicine. 

I  give,  devise  and  bequeath  to  the  Regents  of  the  University  of  Maryland, 
a  coiijoration  incorporated  under  the  laws  of  the  State  of  Maryland,  for  the 

benefit  of  the  Faculty  of  Physic 

(Here  state  amount  or  describe  property.) 

To  Endowment  Fund. 

I  give,  devise  and  bequeath  to  the  Trustees  of  the  Endowment  Fund  of 
the  University  of  Maryland,  a  corporation  incorporated  under  the  laws  of 

the  State  of  Maryland,  for  the  benefit  of  the  Faculty  of  Physic 

(Here  state  amount  or  describe  property.) 


TOU^STG  MEN  S  CHRISTIAN  ASSOCIATIOISr 

ALUMNI  ASSOCIATION. 

MEDICAL  DEPARTMENT. 

President. 

J.   B.    SCHWATKA,   M.D. 

Vice-Presidents. 
J.  M.  H.  RowL-^^ND,  M.D. 
R.  P.  Bay,  M.D. 
€!UY  Steele,  M.D. 

Secretari/. 
W.  S.  Love,  M.D. 

Treasurer. 
C.  U.  Smith,  M.D. 


77 


W.  B.  Perry.  M.D. 
W.  Wise,  M.D. 


Executive  Committee. 
3.  C.  Lumpkin,  M.D. 


H.  W.  Brent,  M.D. 

B.  M.  HoPKiNSON,  M.D. 


Alumni  Advisory  Committee. 
Randolph  Winslow,  M.D. 


R.  L.  Mitchell,  M.D. 
William  J.  Todd,  M.D. 


HiBAM  Woods,  M.D. 
F.  R.  Malone,  M.D. 


'Seci'ologist. 
W.  J.  Todd,  M.D. 


YOUNG  MENS  CHRISTIAN  ASSOCIATION  OF  THE 
UNIVERSITY  OF  MARYLAND. 


The  Y.  M.  C.  A.,  since  its  establishment  twentj-one  years  ago,  has  had  a 
splendid  influence  in  helping  to  mould  the  character  of  the  students  at  the 
rniversity. 

All  students  in  each  department  of  the  University  are  eligible  to  active 
or  associate  membership.  Membership  in  the  University  Association  enti- 
tles the  holder  to  special  privileges  in  the  City  Association.  Bible  and 
Mission  Study  Classes  and  Social  Service  Work  are  promoted  by  the  Asso- 
ciation and  every  effort  is  exerted  to  build  morality  and  strong  Christian 
character. 


78  YOUNG  MEN  S  CHKISTIAN  ASSOCIATION 

A  committee  will  be  on  hand  in  Davidge  Hall  at  the  opening  of  the  ses- 
sion to  welcome  all  new  students  to  the  University.  This  committee  will  be 
glad  to  render  assistance  in  securing  comfortable  rooms  and  boarding 
houses,  and  will  extend  every  other  courtesy  possible.  Each  new  student 
will  be  handed  a  copy  of  the  handbook,  a  publication  issued  by  the  Y.  M. 
C.  A.,  containing  valuable  information. 

All  young  men  who  intend  to  enter  the  University  are  cordially  invited  to 
share  in  the  privileges  and  work  of  the  Association. 

The  otiicers  named  will  be  glad  to  furnish  any  information  desired  in  re- 
gard to  the  Association,  and  will  be  glad  to  render  any  assistance.  Corre- 
spondence should  be  addressed  to  the  president,  William  Hollister. 


INDEX 


Alumni   Association 77 

Annual   Appointments 36 

Board   of  Instruction 6 

Board  of  Regents 4 

Calendar ....  2 

Consolidation   of   Schools 27 

■Curriculum 45 

Dispensaries 33 

Dispensary  Staffs : 

Mercy  Hospital 16 

University   Hospital    12 

Expenses,   Students' 44 

Fees 41 

■Graduates 25 

Hospitals: 

Franklin    Square 30 

James  Lawrence  Kernan 32 

Maternity  Hospital  of  the  Univer- 
sity   of    Maryland 30 

Mercy   Hospital 29 

Mount  Hope  Retreat  for  the  Insane  32 

Municipal  Hospital 31 

Sheppard  and  Enoch  Pratt  Hospital 

for  the  Insane,  The 32 

St.   Vincent's   Infant   Asylum 32 

University   Hospital 28 

West   End    Maternity 31 

Laboratories : 

■  Anatomical 34 

Clinical  Pathology 35 

Histology    and    Embryology 35 


Pathology   and    Bacteriology 35 

Physiology 34 

Physiological   Chemistry 35 

Pharmacology 49 

Libraries 36 

Matriculates 22 

Medical   Council 5 

Postgraduate  Students 40 

Prizes 42 

Prizemen 2ii 

Requirements   for   Matriculation 37 

Rules 41 

Schedule 68 

Scholarships 43 

Special  Courses 42 

Staffs: 

City  Hospital  at  Bay  View 20 

James   Lawrence  Kernan  Hospital.  18 

Mercy  Hospital 13 

Nursery   and   Child's    Hospital....  21 

St.  Elizabeth  Home 20 

St.    Vincent's    Infant    Asylum 21 

University  Hospital 10 

Training  School  for  Nurses: 

Mercy  Hospital 74 

University  Hospital 72 

University  Council 4 

University   of   Maryland.    Organiza- 
tion  of 3 

Young  Men's  Christian  Association..  77 


re  I     rrsB  ™ 


m^  ,A 


UNIVERSITY  OF  MARYLAND 

BULLETIN 

OF  THE 

SCHOOL  OF  MEDICINE 

Vol.  VI  OCTOBER,  1921.  ]^o.  2 


REPORT  OF  TWO  CASES  OF  SYPHILIS  SIMULATINa 
EPITHELIOMATA. 

By  H.  >I.  Robinson,  M.D. 

When  one  engages  in  dermatological  work,  it  is  comparatively 
common  to  meet  with  chronic  ulcerative  lesions  of  the  face,  a 
definite  diagnosis  of  which  can  be  made  only  with  difficulty.  Often 
because  of  the  fact  that  syphilitic  lesions  can  assume  such  various 
aspects,  and  among  other  ulcers  can  imitate  so  closely  epithelio- 
mata,  a  complement-fixation  or  therapeutic  test,  or  microscopic 
examination,  is  necessary  to  determine  the  diagnosis. 

Since,  by  far  (90%).  the  commonest  of  the  chronic  ulcers  of 
the  face  are  lues  and  epitheliomata,  the  emphasis  should  be  laid 
upon  the  chief  diagnostic  points  of  these  two  diseases.  Typical 
cases  illustrating  this  difficulty  of  diagnosis  are  here  recorded,  with 
photogi-aphs. 

1.    Case  of  Gumma  simulating  Epithelioma- 

A.  E.  P.;  aged  30;  married;  white;  male;  American  born; 
chemist  by  profession.  He  denies  any  exposure  to  venereal  infec- 
tion before  marriage,  and  any  disease  of  the  genitalia  at  any  time. 

History  of  Eruption — One  year  after  marriage,  there  appeared 
a  small  pea-sized  nodule  on  the  face  about  half  an  inch  below  the 
right  lower  eyelid.  The  lesion  remained  the  same  for  about  two 
months,  when  it  became  soft  and  was  opened  by  his  wife  with  a 
needle.  A  brownish  fluid  oozed  out  and  in  a  few  days  an  ulcer 
was  formed,  which  retained  its  original  size  and  shape  till  his  first 
visit  for  treatment,  three  weeks  later.  Since  the  ulcer  formed 
there  has  been  no  discharge  or  bleeding.  There  was  slight  pain 
at  times. 


Physical  Examination — No  scars  nor  other  eruption  can  be 
found  on  the  body  other  than  the  present  lesion.  A  thorough 
search  was  made  for  the  remains  of  an  initial  lesion  on  the  penis, 
but  none  was  found.  Half  an  inch  below  the  right  lower  eyelid, 
there  is  a  large  bean-sized,  oval  ulcer,  one  quarter  by  one-half  inch 
in  diameter.  When  first  seen,  the  lesion  had  a  dark  brownish 
crust,  the  removal  of  which  exposed  a  clean-cut  ulcer.  This  ulcer 
had  a  reddish,  ragged,  irregular  base,  with  a  small  amount  of 
grayish  exudate.  Edges  were  slightly  indurated ;  depth  was  about 
one-eighth  of  an  inch. 

A  definite  diagnosis  could  not  be  made  on  clinical  grounds  only. 
A  basal  cell  epithelioma  seemed  to  be  the  most  probable  diagnosis, 
yet  syphilis  as  a  cause  could  not  be  ruled  out.  The  history,  etc., 
slow  growth,  chronicity,  edges  slightly  indurated,  very  scant  dis- 
charge, slight  but  variable  pain,  and,  there  being  no  history  of 
syphilis  or  its  accompanying  signs,  was  in  favor  of  a  diagnosis  of 
cancer.  Against  that  diagnosis  were  the  facts  that  the  edges  were 
not  sufficiently  indurated,  the  color  was  too  dark  red,  and  it  was 
rather  too  deep  to  be  altogether  certain  that  it  was  a  roden  ulcer. 


Gttmma  of  Face. 


The  patient  was  again  closely  questioned  for  a  history  of  initial 
sore  or  other  skin  eruption.  He  was  positive  that  he  had  never 
had  an  eruption  of  any  kind,  except  a  fever  blister  on  his  upper 
lip  fourteen  months  before.  On  further  questioning,  he  said  that 
the  fever  blister  had  remained  in  situ  for  two  months,  during 
which  time  four  physicians  had  seen  it,  diagnosing  it  as  herpes 
simplex.  On  examination,  the  scar  of  this  so-called  herpes  was 
discernible.  The  blood  was  then  examined  by  the  complement- 
fixation  test.  The  report  was  returned  positive.  There  still 
remained  some  doubt  as  to  whether  the  positive  complement-fixa- 
tion test  definitely  indicated  that  the  lesion  was  syphilitic.  It  was, 
therefore,  decided  to  try  the  therapeutic  test.  Patient  then  received 
six  injections  of  Arsenobenzol  0.5  gram  between  October  25th  and 
ISTovember  19th.  The  blood  reaction  following  the  last  injection 
was  doubtful,  but  the  lesion  had  entirely  disappeared,  leaving  only 
a  soft  scar. 


A  differential  diagnosis  of  Gumma  and  Epithelioma; 


Epithelioma  (Basal  Cell). 

Occurs  usually  after  40  years. 

No    history    of    syphilis    nor 

accompanying    symptoms    or 

signs. 

Usually  on  face  and  head. 

Pain  slight,  if  any. 

Discharge,    small   amount, 

often  bloody. 

Bleeds  easily. 

Edges  of  basal  cell  type  are 

hard  and  indurated. 

Very  slow  growth. 


Gnmma. 

1.  Occurs  before  40  years  of  age. 

2.  Very  often  history  of  syphilis. 


3.  Usually  on  lower  extremities. 

4.  Painless. 

5.  Discharge  profuse  and  puru- 
lent. 

6.  Does  not  bleed  easily. 

7.  Edges  not  indurated. 

8.  Moderately  rapid  growth. 


2.    Case  of  Chancre  simulating  Epithelioma. 

This  case  is  interesting  principally  because  the  lesion  was  very 
similar  to  another  of  a  different  diagnosis  on  a  patient  who  came 
to  the  clinic  a  short  time  previously.  These  cases  were  not  as 
difiicult  of  diagnosis  as  the  first  case  cited,  the  age  of  the  patients 
and  duration  of  the  lesions  figuring  largely  in  the  diagnosis. 


A,  S. ;  single;  white;  female;  aged  20;  store  clerk.     Denies 
genital  exposure  and  previous  eruption  of  any  kind.     Is  engaged 


to  be  married  and  had  been  kissing  very 


much. 


Chancke  of  Lip. 

History  of  Eruption — Five  weeks  before  coming  to  the  clinic  a 
small  lump  appeared  on  her  upper  lip.  In  a  few  days  this  lump 
became  moist  and  ulcerated.  Patient  says  the  lesion  has  retained 
its  original  size.  Some  home  remedies  were  tried  without  result, 
and  patient  was  then  brought  to  the  clinic  by  her  fiance,  who  is 
receiving  treatment  for  ccrebro-spinal  syphilis.  Her  fiance  had 
no  eruption  at  the  time,  but  the  laboratory  findings  in  his  case  were 
as  follows: 

Blood  (Wassermann) — Positive. 

Cerebro-Spinal  Fluid  (Wassermann) — Positive. 

Gold  Chloride — Positive  paretic  curve. 

Globulin — Positive. 

Description  of  Lesion — On  the  upper  lip,  slightly  to  the  left  of 
the  mid  line,  there  is  a  round  ulcer  about  five-eighths  of  an  inch 
in  diameter.  Edges  are  raised  and  slightly  infiltrated,  showing  a 
well  defined  margin  (Fig.  2).  Infiltration  and  exudation  slight 
in  amount.    Xo  apparent  palpable  glands ;  little  crusting;  no  pain. 


3.    Case  of  Epithelioma  (Basal  Cell  Type). 

B.  R, ;  aged  54 ;  married ;  white,  male,  mechanic.  Denies  vene- 
real disease  and  any  eruption,  except  present  lesion. 

History  of  Eruption — Two  years  ago  on  the  lower  lip  there 
appeared  a  small  pimple,  which  gradually  ulcerated  and  grew  in 
size  during  the  first  eighteen  months.  For  the  last  six  months 
there  has  been  no  appreciable  growth. 


Epithelioma  of  Lip. 


Description  of  Lesion — On  the  lower  lip,  somewhat  to  the  right 
of  the  mid  line,  there  is  a  well  defined,  round,  superficial  ulcer, 
about  one-half  inch  in  diameter ;  no  exudation.  Crust  thin,  brown- 
ish, and  slightly  tenacious.  Edge  is  thin,  indurated,  and  glisten- 
ing in  appearance.     Practically  no  infiltration ;  no  pain. 

In  these  latter  two  cases,  the  diagnosis  of  chancre  in  Case  2  and 
of  epithelioma  in  Case  3  was  partially  decided  by  the  duration  of 
the  lesions,  the  former  being  acute  and  the  latter  chronic;  and 
finally  by  a  dark  field  illumination  examination  in  Case  2  and  a 


biopsy  in  Case  3.     Spirochsetes  were  found  in  the  dark  field  and 
epitheliomatons  pearls  in  the  biopsy. 

From  this  illustration  of  the  value  of  these  examinations,  it  is 
urged  that  greater  resort  be  had  to  routine  complement-fixation 
(Wassermann)  test  and  biopsies. 

OPEN  THORAX. 

By  Nathan  Winslow,  M.D. 

Owing  to  the  fear  of  collapse  of  the  lung,  with  death  from 
asphyxia,  intrathoracic  surgery  had  made  but  slight  progress  until 
the  Great  War  demonstrated  that  surprisingly  large  openings  in 
the  chest  wall  are  not  necessarily  fatal.  The  observations  of  Duval 
and  Piery  had  much  to  do  with  the  changing  of  the  prevalent 
notion  that  compression  of  the  lung  was  fatal  and  had  to  be 
guarded  against  by  cumbersome  apparatus  if  the  interior  of  the 
chest  was  to  be  attacked  successfully.  These  men  have  demon- 
strated the  lung  to  be  open  to  operative  attack  with  the  hope  of  a 
reasonable  meed  of  success  without  recourse  to  any  special  safe- 
guards to  combat  pneumothorax.  E.  A.  Graham,  Annals  of  Surg., 
1921,  LXXII,  170,  advances  the  view  that  on  open  pneumo- 
thorax on  one  side  produces  practically  an  equal  amount  of  com- 
pression of  both  lungs  instead  of  entire  collapse  of  one  lung  with 
the  maintenance  of  respiration  by  the  other.  If  this  were  not  true, 
he  states,  the  establishment  of  atmospheric  pressure  within  a  pleu- 
ral space  would  never  prove  fatal  regardless  of  the  size  of  the 
wound,  as  the  other  lung  would  be  capable  of  maintaining  life. 
Similarly,  he  says,  a  bilateral  open  chest  should  always  be  promptly 
fatal.  Both  experimental  and  war  experience  controvert  the  old 
conceptions.  Experimentally,  it  is  easy  to  demonstrate  that  a  defi- 
nite quantitative  relationship  exists  between  the  size  of  the  opening 
in  a  penetrating  chest  injury  in  any  individual  and  the  danger  of 
death.  The  important  factor  is  the  amount  of  air  which  enters  the 
chest  from  the  outside  with  each  inspiration.  Theoretically,  the 
approximate  size  of  the  maximum  opening  compatible  with  life  if 
the  mediastinum  has  a  normal  mobility  can  be  accurately  ascer- 
tained, but  practically  the  opening  must  be  somewhat  smaller,  since 
the  extra  work  performed  by  the  muscles  of  respiration  to  estab- 
lish compensation  increases  the  amount  of  air  required,  and  the 
presence  of  toxemia,  infection  and  other  factors  increasing  the 
level  of  metabolism  will  decrease  the  safety  limits  of  the  maximum 
size  of  the  opening.  In  a  person  of  3700  c.  c.  vital  capacity, 
Graham  advances  8  sq.  in.  as  the  largest  opening  for  which  com- 
pensation can  be  made  if  the  mediastinum  has  a  normal  mobility. 
He  states  it  makes  but  little  difference  if  the  pneumothorax  be  uni 


or  bilateral,  provided  the  combined  areas  of  tbe  openings  be  not 
in  excess  of  the  8  sq.  in. 

In  this  connection  I  desire  to  report  a  case  of  multiple  stab 
wounds  penetrating'  the  thoracic  wall.  One  of  the  wounds  was 
sufficiently  large  to  afford  an  unhampered  view  of  the  lung  expand- 
ing and  contracting  with  each  expiration  and  inspiration.  The 
lung  was  compressed  to  less  than  half  of  its  normal  size  and 
crowded  against  the  posterior  wall  of  the  thorax.  The  lower  mar- 
gin during  expiration  barely  reached  the  4th  rib  on  a  level  with 
the  anterior  axillary  line. 

C.  W.,  a  colored  man,  married,  aged  35  years,  was  stabbed  in 
the  chest  with  a  large  penknife  by  his  brother-in-law  in  a  quarrel 
about  6  P.  M.,  May  6,  1920.  There  were  two  wounds  in  the  lower 
part  of  the  left  side  of  the  chest,  the  upper  and  larger  some  four 
inches  long  between  the  7th  and  8th  ribs  and  centering  on  the 
anterior  axillary  line,  the  lower  between  the  10th  and  11th,  an 
inch  in  length.  Beneath  the  skin  of  the  latter  was  a  large  hema- 
toma which  caused  a  bulging  of  the  integument.  The  respiration 
was  embarrassed,  the  pulse  accelerated  and  the  expression  anx- 
ious. He  complained  of  severe  pain  in  the  chest  on  the  injured 
side.  Palpation,  percussion  and  auscultation  showed  the  lung  to 
be  partially  collapsed.     Operation  was  advised  and  accepted. 

Operation  (5/6/20) — Ether  Anesthesia — Iodine  Technic — Exploration  and 

Suture — Cured. 

In  retracting  the  upper  wound,  the  pleura  was  found  to  be  open 
for  three  inches  of  its  extent  and  the  left  lung  collapsed  to  about 
one-half  of  its  volume.  The  wound  tract  was  iodinized  and  a 
debridement  done  and  the  wound  closed  tight.  The  lower  wound 
was  enlarged,  and  when  traced  to  the  bottom  was  likewise  found  to 
enter  the  pleural  cavity.  It  was  handled  in  the  same  manner  as 
the  upper  lesion,  after  having  removed  the  clotted  blood.  A  small 
amount  of  free  blood  was  detected  in  the  pleural  cavity.  The  dia- 
phragm was  not  injured.  The  patient  was  returned  to  bed  in  good 
condition.  His  temperature  never  went  above  100,  pulse  100,  and 
respiration  30.  By  5/13/20  all  were  normal  and  the  man  was 
discharged  cured  5/16/20. 

Although  the  cl(>sure  of  a  gaping  wound  in  the  chest  wall  is 
desirable  in  order  to  overcome  embarrassed  respiration,  do  not 
regard  it  as  the  essential  object.  Such  an  operation  is  in  reality 
an  incomplete  one.  Extraneous  matter  must  be  removed,  lacera- 
tions appropriately  handled,  hemorrhage  checked,  and  sepsis  com- 
batted  before  the  external  trauma  is  sealed.  Eecent  experience 
has  shown  that  compression  is  a  beneficent  rather  than  a  malign 
influence  in  that  it  serves  a  useful  purpose  in  checking  hemor- 


rliagc  and  by  permitting'  when  occasion  demands  eventration  of 
the  hmg,  lobe  by  lobe,  palpation,  incision,  resection  and  replace- 
ment of  the  lung-  in  the  thorax — acts  impossible  of  accomplish- 
ment if  the  lung  be  expanded.  Intrathoracic  surgery  has  come 
into  its  own,  and  either  an  accidental  or  artificial  open  thorax  is 
not  the  serious  affair  it  was  once  supposed  to  be.  Lacerations  of, 
hemorrhage  from,  foreign  bodies  in,  tumors  and  abscesses  of  the 
lungs  are  attacked  now  by  surgeons  boldly  and  with  almost  as 
little  concern  as  the  same  conditions  within  the  peritoneal  cavity. 
For  this  we  have  to  thank  the  experience  gained  in  the  war, 

*BEFERRED  PAIN  OF  SOME  ABDOIVfllVAL  CONDITIONS. 
By  Leon  Freedom,  MJ). 

There  are  certain  subjective  symptoms  which  are  of  exceedingly 
great,  although  varying,  importance  in  diagnosis,  especially  pain, 
and,  even  though  pain  may  not  be  diagnostic,  it  may  furnish  an 
important  clue  as  to  the  nature  of  the  disease.  On  the  other  hand, 
in  many  common  diseases,  there  may  be  an  absolute  lack  of  any 
pain  or  tenderness,  so  that  a  most  important  symptom  is  missing. 
Since  pain  is  purely  subjective,  its  intensity  can  only  be  estimated 
by  the  assertions  of  the  sufferer  and  the  diiferences  in  susceptibil- 
ity of  races,  as  well  as  individuals,  must  be  taken  into  considera- 
tion, i.  e.,  Semitic  being  so  hypersensitive  as  compared  to  Teutons 
and  Slavs,  neurotics,  etc. 

The  manner  of  life  greatly  modifies  the  susceptibility.  One 
used  to  hardships  has  great  endurance.  Christian  Scientists  refuse 
to  admit,  etc.  Expectant  apprehension  increases  it  and  often  is  its 
origin.  Some  understate  the  pain  they  suffer  from  pride,  while 
others  magnify  without  any  thought  of  deceiving  the  physician. 
This  is  most  likely  due  to  the  subconscious  egotism  of  their  illness 
and  desire  to  get  better  by  impressing  the  physician  with  the 
severity  of  their  condition. 

There  are  several  things,  however,  which,  if  carefully  investi- 
gated, will  prevent  deception,  and  that  is — in  the  presence  of  really 
severe  pain,  respiration  is  rapid,  pupils  are  dilated,  the  skin  is 
moist  with  perspiration,  pulse  is  often  tense.  There  is  a  feeling 
of  faintness  and  often  a  quite  large  amount  of  limpid  urine  is 
passed  within  a  short  period.  These  all,  however,  are  not  so  fre- 
quently present. 

We  know  there  are  many  varieties  of  pain,  varying  from  a  dull 
ache  to  a  sudden  sharp  or  acute  pain,  and  we  are  aware  of  the  diag- 
nostic value  of  the  character  of  pain — i.  e.,  the  acute  pain  of  acute 
pleurisy  or  joint  involvement. 

♦Read  before  the  Randolph-Winslow  Surgical  Society,  January  25,  1921. 


9 

What  concerns  us  here  is  the  diagnostic  importance  of  the  seat 
of  pain. 

Head  explains  referred  pain  in  this  way:  When  a  powerful 
stimulus  is  applied  to  an  organ  which  normally  possesses  a  low 
degree  of  sensibility,  the  pain  produced  is  felt  in  the  part  which 
is  relatively  more  sensitive.  Consequently,  the  tenderness  of  the 
skin  in  visceral  disease  is  due  to  the  passing  of  sensory  impulses 
from  a  diseased  organ  to  its  corresponding  spinal  segment,  these 
impulses  causing  a  disturbance  in  the  segment  of  such  a  nature 
that  any  additional  impulses  coming  from  the  skin  surface,  with 
which  this  is  connected,  will  be  increased  and  modified  so  as  to 
produce  abnormal  or  painful  impressions  which  are  referred  in 
consciousness  to  the  part  of  higher  sensitiveness,  the  skin.  Accord- 
ing to  Bevan :  referred  pain  is  the  name  given  to  that  class  of  pain 
in  which  the  irritation  occurs  along  the  course  of  the  nerve  fibers, 
and  the  pain  is  felt  as  being  produced  in  the  somatic  peripheral 
distribution  of.  the  affected  nerve  or  nerves.  These  are  three  places 
where  the  irritation  may  cause  referred  pain : 

1.  Cord.  When  irritation  is  in  cord,  the  pain  sensation  is 
referred  along  the  pain  paths  of  the  same  side  of  the  lx>dy. 

2.  Lesions  of  the  post  roots.  That  is,  girdle  pains  of  locomotor 
ataxia,  transverse  cord  tumors. 

3.  Lesions  occurring  somewhere  on  the  nerve  circuit.  This 
makes  up  the  largest  class.  If  the  lesion  occurs  on  the  trunk,  pain 
is  always  referred  to  a  point  distal  to  the  area  at  which  it  occurs ; 
but  if  the  irritation  is  on  a  branch,  it  may  be  referred  to  the 
periphery  in  an  area  proximal  to  that  in  which  it  occurred. 

Reflected  pain  differs  from  referred  pain.  In  the  former,  the 
stimulus  is  carried  to  the  sensory  ganglia  or  to  the  cord  and  then 
transferred  from  the  sensory  filaments  of  the  neuron  primarily 
affected  to  those  of  a  secondary  neuron.  The  stimulation  is  then 
carried  in  the  neuronic  pathway  to  the  brain,  and  is  perceived  as 
coming  from  the  distribution  area  of  the  2nd  neuron ;  the  difference 
from  referred  pain  being  that,  in  referred  pain  there  is  a  mis- 
reference  of  the  pain  by  the  sensorium,  while  in  reflected  pain 
there  is  a  transference  of  painful  stimuli  from  one  neuronic  sys- 
tem to  another.  These  deflections  have  an  anatomical  basis  (ac- 
cording to  Lickley),  for  recent  researches  show  that  the  nerve  cells 
(in  a  segment)  of  the  cord  undergo  degeneration  as  a  result  of  any 
lesion  in  the  corresponding  segmental  distribution  area.  This 
confirms  the  hypothesis  that  stimuli  causing  pain  arise  from  direct 
irritation  from  pathological  changes  in  the  cord,  and  are  not  due 
simply  to  a  transfer  of  stimuli  from  one  set  of  cells  to  another. 

The  most  numerous  and  important  of  reflected  pains  are  those 
due  to  pathological  changes  in  the  intestinal   viscera.     Viscera 


10 

themselves  have  no  pain  sensation,  as  elicited  by  ordinary  pain- 
producing  stimnli.  They  can  be  cut,  torn,  sutured,  etc.,  without 
producing  pain ;  they  are  insensible  to  heat  and  cold,  yet  they  do 
have  a  sense  of  their  own  which  tells  of  their  well-being,  especially 
when  distended.  When  viscera  are  irritated  the  stimuli  are  car- 
ried to  the  cord  and  react  on  cord  cells ;  the  impulses  are  produced 
and  sent  out  as  motor  impulses  or  are  carried  to  the  brain  and 
perceived  as  painful.  At  the  same  time,  the  adjacent  set  of  cells 
becomes  irritable  and  react  abnormally  to  all  stimuli  reaching 
them  from  the  periphery.  These  are  the  so-called  hyperalgesic 
zones  of  Head.  These  zones  are  not  always  present  over  the  area 
of  the  involved  viscera  (as  explained  by  McKenzie)  that,  in  the 
course  of  development  the  tissues,  which  in  a  low  form  of  life  must 
immediately  have  covered  the  organ,  become  displaced.  In  this 
way,  several  peculiarities  in  pain  production  may  be  explained. 

Why  do  we  have  pain  in  the  testicle  in  ureteral  colic  ?  In  early 
foetal  life,  the  testicle  was  very  high  in  the  abdomen  and  was  sup- 
plied by  the  first  lumbar  segment.  Then  it  journeyed  through  the 
abdominal  ring  to  the  scrotum,  always  retaining  its  same  nerve 
supply.  The  ureter,  likewise,  receives  its  nerve  supply  from  the 
same  segment,  so  that  when  irritation  occurs  in  the  ureter,  the 
pain  is  often  referred  to  and  is  felt  as  arising  in  the  testicle,  which 
at  the  same  time  is  tender.  In  renal  colic,  the  skin  of  the  scrotum 
being  supplied  by  the  sacral  nerves,  the  deep  coverings  of  the 
testicle  are  always  hyperalgesic,  because  they  are  in  relation  with 
the  same  cord  segment  as  the  kidney  (Bevan).  In  kidney  involve- 
ment, the  nerve  supply  coming  from  the  tenth,  eleventh  and 
twelfth  dorsal  and  first  lumbar  segments,  all  the  tissues  supplied 
by  the  following  nerves  arising  in  these  segments  by  the  ilio-hj'^po- 
gastric,  also  ilio  inguinal,  genito-crural,  external,  middle  and  inter- 
nal cutaneous  and  obturator  nerves  may  be  involved,  so  we  can  see 
how  widespread  referred  pain  may  be,  even  to  the  anus,  rectum, 
labia  majora  and  in  some  cases  as  far  down  as  the  ankle. 

Dr.  Howard  Kelly  says  that  60  per  cent,  of  cases  having  ill- 
defined,  right-sided  pain  have  disease  of  the  kidney.  In  a  study 
of  300  cases  of  abdominal  pain  in  disease  of  the  kidney  and  ureter 
by  Cecil,  the  classical  pain,  beginning  in  the  region  of  the  superior 
lumbar  triangle  and  radiating  to  the  lower  abdomen,  genitalia  and 
thigh,  was  present  in  only  21  cases,  and  in  20  per  cent,  of  these 
cases  the  pain  was  so  misleading  as  to  cause  operation  for  gall 
bladder  and  appendix;  in  28  per  cent,  of  the  cases  of  stone,  the 
pain  was  limited  to  the  abdomen. 

A  condition  frequently  overlooked  is  hydro-nephrosis  or  hydro- 
ureter,  as  shown  by  Hunner,  due  either  to  stone  formation  or  ure- 


11 

teral  stricture,  in  which  pain  occurred  in  the  right  and  left  upper 
and  lower  abdomen  and  back,  in  either  or  both ;  and  was  so  mis- 
leading as  to  be  diagnosed  ptomaine  poisoning,  acute  gall  bladder 
or  appendix. 

Dr.  Braasch,  of  the  Mayo  Clinic,  states  that  fully  half  of  the 
patients  with  lesions  in  the  right  kidney  and  ureter  have  had  opera- 
tions on  adjacent  organs;  while  the  kidney  and  ureter  conditions 
were  passed  over  unrecog-nized.  He  states  that  at  the  Mayo  Clinic 
it  is  now  the  custom  to  refer  every  patient  with  abdominal  pain, 
which  has  not  been  definitely  identified  by  abdominal  examination, 
for  an  X-ray  examination  of  the  urinary  tract  and  then  to  the 
urologist.  For  every  case  in  which  (1)  pus  and  blood  is  found 
in  urine;  (2)  or  history  of  either;  (3)  every  doubtful  abdominal 
tumor. 

Dr.  Fowler,  of  Washington,  declares:  "In  any  case  of  abdom- 
inal pain,  when  in  doubt,  suspect  the  kidney."  Dr.  Hyman,  of 
New  York,  when  in  doubt,  always  cystoscopes  and  uses  X-ray 
examination,  especially  in  chronic  cases. 

Peritoneal.  Pain  produced  by  three  things :  ( 1 )  inflammation, 
(2)  hemorrhage,  (3)  new  growths.  MacKenzie  found  that  the 
peritoneum  is  not  supplied  by  nerves,  but  the  sub-peritoneal  tissue 
is  abundantly  supplied ;  the  same  nerves  going  to  the  abdominal 
muscles ;  therefore  the  rigidity  when  peritoneum  is  affected. 

Occasionally  cases  occur  in  which  there  is  no  pain ;  may  be  due 
to  quantity  of  pus,  or  to  the  rapid  destruction  of  nerve  endings  or 
impairment  of  their  efficiency  (Bradford)  ;  this  frequently  occurs 
in  puerperal  sepsis.  In  tuberculosis  peritonitis,  pain  is  frequently 
confused  with  referred  pain  from  visceral  involvement. 

Stomach  disorders  are  referred  to  the  epigastrium  and  to  the 
back  between  the  posterior  borders  of  both  scapulse  and  opposite 
the  spinous  process  of  the  fifth  dorsal  vertebra.  Pain  often  circles 
around  from  one  of  these  areas  to  the  other,  and  they  are  often 
tender  to  touch.  Authorities  disagreed  as  to  the  exact  area;  but 
Head  places  the  points  of  maximum  tenderness  opposite  the  ninth 
and  tenth.  As  a  matter  of  fact,  it  may  be  felt  in  any  area  from 
the  fifth  to  the  ninth  dorsal  vertebra,  especially  the  maximal  points 
of  tenderness  in  this  area. 

In  gastric  pain  it  is  necessary  to  inquire  into  (1)  the  character 
of  pain,  (2)  time  and  manner  of  appearance,  (3)  relation  to 
ingestion  of  food,  (4)  duration  of  pain,  (5)  previous  attacks,  etc. 
In  gastric  ulcer,  pain  is  dull  and  boring,  begins  at  the  entrance 
of  food  into  the  stomach,  usually  in  the  epigastrium  and  slightly 
to  the  left,  although  it  is  claimed  by  many  that  the  position  of 
the  ulcer  on  the  stomach  as  well  as  the  position  of  the  stomach 
influences  the  site  of  pain.     Some  conditions  frequently  causing 


12 

pain  in  the  epigastriiuu  and  simulating  gastric  pain  are:  (1)  gall- 
stone colic,  (2)  cholecystitis,  (3)  pyloric  and  duodenal  ulcer,  ac- 
cording to  Bevan,  (4)  acute  pancreatitis,  (5)  angina  pectoris, 
(6)  acute  appendix,  (7)  renal  colic,  (8)  gastric  carcinoma,  (9) 
aortic  aneurism,  (lO  uterine  and  ovarian  disorders.  (11)  inter- 
costal neuralgia,  and  other  nervous  diseases  such  as  locomotor 
ataxia,  etc. 

Intesiijial  pains.  Pain  is  usually  imperfectly  localized,  but 
after  much  consideration  over  the  matter,  MacKenzie  has  come  to 
the  following  conclusions :  That  (1)  if  the  lesions  are  of  small  gut, 
the  pain  is  reflected  to  the  anterior  abdominal  wall  in  the  interval 
between  the  navel  and  xyphoid.  (2)  If  in  large  gut.  the  pain  is 
felt  slightly  below  the  navel.  (3)  In  lesions  of  the  rectum  and 
sigmoid,  it  is  felt  directly  above  the  pubes.  Xearly  all  painful 
intestinal  lesions  are  circum-umbilical.  In  appendicitis  this  is 
very  common,  that  as  pathology  progTCsses  the  site  of  pain  is 
changed  from  the  umbilical  region  to  the  right  lower  quadrant.  In 
diseases  of  small  gut,  pain  is  generally  felt  above  umbilicus ;  in 
large  gut.  l:>elow.  A  peculiar  characteristic,  and  one  which  fre- 
quently holds  true,  is  that  in  large  gut  diseases,  pressure  on  the 
abdomen  over  the  site  of  the  colon  (which,  in  its  transverse  divi- 
sion is  above  umbilicus,  and  in  ascending  and  descending  to  either 
side  of  it)  will  produce  pain  in  the  mid-abdominal  zone,  without, 
in  many  cases,  producing  pain  at  the  point  of  pressure.  In  lesions 
of  small  intestine  the  contrary  holds  true,  for  pressure  below 
causes  pain  above  the  umbilicus. 

If  the  pain  that  is  felt  closely  resembles  that  of  stomach,  as  is 
often  the  case  in  duodenal  ulcers,  and  examination  of  stomach 
does  not  reveal  any  abnormality,  suspect  the  duodenum.  It  is 
very  common  of  the  duodenum,  because  of  proximity  to  stomach, 
to  produce  disturbances  similar  to  gastric.  In  some  cases,  intes- 
tinal pain  from  disease  is  felt  in  the  back  in  one  or  the  other  lum- 
bar region.  Pain  in  the  back  generally  alternates  with  pain  in 
the  anterior  abdominal  wall.  As  a  rule,  both  are  not  coincident. 
Visceral  pain  depend?  for  its  localization  largely  upon  the  fixity 
or  mobility  of  the  organ  affected.  The  more  fixed  the  part,  the 
more  constant  the  pain.  In  movable  small  gut.  the  localization  is 
diffuse  and  centralizes  chiefly  about  umbilicus.  In  fixed  parts, 
the  pain  is  usually  felt  where  they  are  joined  to  the  abdominal 
wall. 

As  to  the  special  parts  of  the  rectum,  colon,  appendix  and  anus : 
Colon — the  pain  in  colon  disease,  especially  impaction,  seems  to 
be  most  pronounced  in  right  or  left  hypochondriac,  accordinir  to  its 
seat,  and  frequently  referred  along  the  anterior  lateral  or  posterior 


13 

aspects  of  thigh.  Rectum — local  conditions,  such  as  ulcer,  new 
growth,  stricture,  etc.,  since  the  rectum  is  highly  insensitive  to 
pain,  the  pain  is  frequently  referred  down  the  back  part  of  the 
thigh,  even  to  the  penis,  or  labia  in  female.  Pain  may  be  referred 
to  the  rectum  in  diseases  of  the  uterus,  ovary,  tubes,  prostate,  post- 
urethra  and  vesical  trigone,  associated  with  constant  desire  to  go  to 
stool.  Nervous  conditions  frequently  cause  rectal  referred  pain, 
epilepsy,  locomotor  ataxia  crises,  neuralgia  and  hysteria. 

Anus.  Is  extremely  sensitive,  and  organic  conditions  are  never 
difficult  in  diagnosis. 

Appendix.  Is  connected  to  the  tenth  and  eleventh  spinal  seg- 
ments, which  supplies  also  the  recti  abdominal  muscles ;  there- 
fore causing  rigidity  arising  from  the  intra-abdominal  changes  of 
appendiceal  involvement;  principally  at  McBurney's  point. 

Pain  may  be  referred  to  the  abdominal  wall  of  the  same  side, 
or  to  the  tunica  vaginalis  testis  and  also  to  the  sacro-iliac  region. 
It  may  be  transferred  at  a  higher  or  lower  level  on  the  same  or 
opposite  side  of  the  abdominal  wall.  Conditions  frequently  simu- 
lating appendicitis  are:  (1)  colitis,  (2)  intussusception,  (3)  gall 
stone,  (4)  renal  colic,  (5)  ovarian,  (6)  tubal  disease,  (7)  hydro- 
nephrosis, (8)  sciatica,  (9)  lumbago,  (10)  ectopic  pregnancy, 
(11)  strangulated  hernia  and  peritonitis.  Chermise  describes  a, 
condition  occurring  in  lues,  flu  and  hysteria  in  which  much  pain 
occurs  about  McBurney's  point. 

Diseases  of  liver,  gall  bladder  and  ducts :  may  be  affected  by 
inflammation,  obstruction  from  new  growths  or  bodies,  adhesions, 
displacement,  etc.  The  nerve  supply  is  chiefly  sympathetic,  but 
the  fifth  and  sixth  dorsal  segments  help  the  gall  bladder  and  the 
eighth,  ninth  and  tenth  help  the  liver.  The  intercostals,  as  was 
frequently  thought,  do  not  supply  the  liver. 

The  vagus  also  assists  in  liver  innervation;  so  many  cases  of 
common  duct  diseases,  especially  when  the  area  near  the  junction 
of  the  hepatic  and  cystic  duct  is  involved,  the  pain  producing 
stimulus  is  carried  through  the  branch  from  the  adjacent  sympa- 
thetic ganglion  to  the  left  vagus,  and  thence  to  the  fourth  and 
fifth  dorsal  segments,  from  whence  it  is  reflected  to  the  chest  wall 
in  the  distribution  area  of  these  segments.  This  explains  why 
pain  is  sometimes  felt  on  the  left  anterior  wall  of  the  chest  at 
about  the  level  of  the  fourth  and  fifth  costal  cartilages ;  sometimes 
confused  with  pneumonia.  Pain  in  the  right  shoulder  also  fre- 
quently occurs  in  liver  disease.  This  is  explained  by  the  stimuli 
being  referred  through  the  right  phrenic;  the  diaphragm  being 
involved  by  a  lymphangitis  spreading  from  an  inflamed  liver  or 
gall  bladder. 


14 

The  liver  and  gall  bladder  are  insensible  to  pain — i.  e.,  pres- 
sure, heat  and  cold,  as  well  as  faradic  stimulation.  However,  pull- 
ing on  the  common  duct  or  tilting  of  liver  will  cause  pain. 

With  the  abdomen  relaxed,  place  the  hand  flat  on  the  anterior 
surface  with  finger  tips  deviated  toward  the  liver,  and  palpation 
carried  on  in  the  usual  way,  etc.  If  during  the  acme  of  inspira- 
tion pain  is  felt,  it  indicates  a  peri-hepatitis  or  gall  bladder  dis- 
ease. In  peri-hepatitis  the  pain  frequently  radiates  to  the  front, 
of  the  right  shoulder. 

This  may  be  differentiated  from  gall  bladder  disease  by  request- 
ing patient  to  sit  upright,  remove  fingers  to  region  of  gall  bladder 
and  request  patient  to  take  a  deep  inspiration.  Should  there  occur 
a  sudden  stopping  of  inspiration,  accompanied  by  a  grunt,  gall 
bladder  disease  is  indicated. 

Tenderness  at  Mayo  Eobson's  point  is  supposed  to  indicate 
inflammation  of  the  gall  bladder  or  ducts;  this  tenderness  lies 
along  a  line  extending  from  the  top  of  the  ninth  costal  cartilage  to 
the  umbilicus.  The  point  of  greatest  tenderness  lies  on  this  line, 
1  inch  to  the  right  of  the  umbilicus. 

Murphy  differentiates  gall  bladder  pain  and  tenderness  from 
lesions  of  other  organs. 

Place  patient  in  sitting  position,  bent  well  forward,  hands  rest- 
ing on  knees.  The  examiner  now  stands  behind  patient  and  places 
his  hand,  with  the  palm  flat  against  the  abdomen  immediately 
below  ribs  on  right  side.  Tell  patient  to  take  deep  breaths.  After 
each  expiration  the  examiner's  hand  follows  the  abdominal  wall 
until  it  approaches  closely  to  the  affected  gall  bladder  and  adja- 
cent tissues,  when  suddenly  the  patient  ceases  breathing  with  a 
gasp  and  complains  of  severe  pain.  This  indicates  the  hand  has 
touched  inflamed  tissues. 

In  gall  bladder  disease  the  patient  frequently  complains  of  pain 
radiating  to  right  nipple  and  backward  to  the  shoulder  blade  and 
thence  to  the  lumbar  region.  Schmidt  claims  that  radiation  of 
pain  into  the  genitals  with  retention  of  urine  may  occur.  Pain 
may  radiate  to  the  right  iliac  fossa  and  be  confused  with  appen- 
dix, although  oftentimes  both  are  simultaneously  involved. 

Pain  referred  to  a  distance  seldom  occurs  except  in  neurasthen- 
ics, in  which  they  might  complain  of  pain  radiating  to  the  back  of 
the  head  and  down  the  spine.  The  location,  direction  and  radia- 
tion of  pain  helps  distinguish  gall  bladder  pains  from  that  due  to 
kidney,  duodenum  or  stomach.  If  the  gall  bladder  is  inflamed, 
pressure  over  it  will  cause  pain  to  appear  in  the  right  shoulder 
and  in  the  epigastrium,  to  the  right  of  the  median  line;  remem- 
bering the  classical  most  tender  area  is  at  the  junction  of  the  ninth 
and  tenth  costal  cartilage  and  costal  arch.     Schmidt  claims  that  in 


15 

gall  bladder  disease  there  is  a  point  of  tenderness  over  the  acro- 
mion. Pressure  at  this  point  causes  pain  which  radiates  to  gall 
bladder;  vice  versa,  pressure  over  gall  bladder  causes  pain  v^hich 
radiates  to  this  area.'  He  said  that  this  condition  occurs  in  liver 
abscess  and  subphrenic  inflammations  and  seem  to  be  most  pro- 
nounced when  diaphragm  is  involved. 

Gall  duct  pain  is  located  in  epigastrium;  may  be  referred  to 
anterior  chest  wall  at  about  the  fourth  to  sixth  left  costal  carti- 
lage. Pain  from  cystic  duct  disease  may  be  referred  to  right  of 
vertebral  column,  between  the  eighth  and  eleventh  dorsal  vertebrae, 
while  hepatic  duct  pain  may  be  referred  to  the  right  hypochon- 
drium,  to  the  thigh,  and  even  to  the  head  and  neck.  In  some 
cases,  it  has  been  mistaken  for  angina  pectoris;  in  other  cases  it 
may  begin  in  the  epigastrium  and  radiate  over  the  abdomen  to 
the  right  sub-scapular  region  and  has  been  felt  even  in  the  right 
lumbar  region ;  has  been  known  to  radiate  to  the  left  shoulder. 

Pancreas.  Closely  related  to  the  pancreas  are  the  large  sympa- 
thetic ganglia ;  pressure  on  these  ganglia  causes  a  disturbance  which 
is  reflected  as  pain  through  the  medullated  nerves  supplying  the 
body  wall.  Pressure  on  the  superior  mesenteric  vessels  and  nerves 
causes  pain  referable  to  the  small  intestine;  should  inflammation 
extend  to  other  organs,  we  get  signs  and  symptoms  of  their  in- 
volvement in  addition  to  pancreatic  lesions.  The  Pancreas  is  al- 
most entirely  surrounded  by  duodenum,  on  either  side  by  kidney, 
the  common  bile  duct  passes  through  its  substance.  Consequently, 
any  one  part  affected  influences  the  others. 

Schmidt  says  it  is  well  to  think  of  possibility  of  pancreatic 
lesions  in  all  cases  of  apparent  peritonitis  or  intestinal  obstruc- 
tions, as  well  as  colicky  abdominal  pain  following  epigastric 
blows  or  trauma.  If  in  these  conditions  no  indication  is  found  in 
the  urine,  but  glycosuria  appears  spasmodically  or  constantly  after 
attacks  of  pain,  this  should  strongly  suggest  pancreas.  Our  opin- 
ion is  much  strengthened  if  stool  examination  shows  insufficient 
digestion  of  albumin  and  fats  and  the  physical  examination  justi- 
fies consideration  of  pancreatic  disease.  The  pain  in  pancreatic 
disease,  when  present,  is  generally  in  the  left  epigastrium,  and 
radiates  to  the  left  inguinal  region,  or  to  the  back  under  the  left 
scapula  (different  disease  from  gall  bladder,  which  radiates  under 
right  scapula).  Should  the  pain  be  present  in  the  epigastrium; 
and  radiate  around  to  both  sides  of  the  thorax,  it  generally  indi- 
cates a  calculus.  If  the  coeliac  plexus  is  involved,  pain  radiates 
to  cardiac  region  and  resembles  angina  pectoris.  Because  of  the 
absence  of  peritoneum  on  the  posterior  surface  of  the  pancreas  and 
of  the  intimate  relationship  which  it  has  to  the  post  abdominal 


16 

wall,  pressure  made  to  either  side  of  the  second  or  third  lumbar 
vertebra  is  also  provocative  of  considerable  pain. 

Acute  pancreatitis,  a  condition  only  diagnosed  after  finding  fat 
necrosis  when  a  low  abdominal  incision  has  been  made  for  sus- 
pected ulcer  or  low  abdominal  conditions,  is  frequently  overlooked. 

Fitz  says,  suspect  acute  pancreatitis  in  a  previously  healthy 
person,  or  one  who  has  had  previous  attacks  of  indigestion,  when 
suddenly  seized  with  violent  pain  in  epigastrium,  followed  by 
vomiting  and  collapse,  and  in  twenty-four  hours  by  a  circum- 
scribed epigastric  swelling,  tympanitic  or  constant,  with  slight 
rise  in  temperature. 

In  pancreatic  disease,  pain  may  radiate  to  the  back,  between  the 
shoulder,  to  McBurney's  point,  to  the  legs  and  to  the  lumbar  re- 
gion. 

Spleen..  Involvement  of  the  spleen  frequently  results  in  ten- 
derness over  the  splenic  area,  but  very  few  lesions  cause  acute  pain, 
although  when  pain  is  absent  there  is  a  feeling  of  pulling  or  drag- 
ging in  the  left  hypochondrium,  or  a  sense  of  tension  in  the  splenic 
area  or  dragging  in  the  epigastrium.  A  very  significant  feature  of 
splenitis  is  tenderness  of  the  left  pneumogastric,  and  in  a  series  of 
10  cases  reported  by  Embleton,  in  6  the  left  pneumogastric  was 
tender  in  pressure  and  in  2  to  the  right. 

Frequently  pain  of  splenic  involvement  is  found  referred  in  the 
•shoulder  over  the  acromion  process  and  at  the  junction  of  the 
middle  and  upper  thirds  of  the  upper  edge  of  the  trapezius  muscle'. 
The  classical  pain  area  is  known  as  Signorelli's  spleen  point ;  near 
the  intersection  of  the  left  fifth  intercostal  space  and  the  mid  cla- 
vicular line. 

In  conclusion,  use  the  following  method  of  localizing  the  viseus 
causing  the  reflected  pain : 

1.  Determine  if,  in  connection  with  it,  there  is  an  associated 
area  of  hyperalgesia. 

2.  Delimit  the  area  of  hyperalgesia  as  nearly  as  possible,  and 
orient  it  with  a  cord  segment. 

8.     Find  out  the  organs  supplied  by  this  segment. 

4.  ^  Examine  the  organ  or  organs  for  disease. 

5.  See  if  the  pain  can  be  reproduced  by  manipulation  of  the 
organ. 


17 


EDITORIAL 

THE  NEW  PROFESSOR  OF  MEDICINE. 

Expressions  of  satisfaction  are  being  heard  everywhere  upon  the 
appointment  of  Doctor  Maurice  C.  Pincoffs  as  professor  of  medi- 
cine and  director  of  the  medical  department  in  the  University  of 
Maryland.  Doctor  Pincoffs  has  been  for  a  number  of  years  with 
Doctor  L,  F.  Barker  as  an  assistant.  He  is  a  young  man  of  excel- 
lent attainments  and  pleasing  personality,  who  comes  to  us  highly 
recommended.  The  appointment  marks  an  epoch  in  the  history  of 
the  University  of  Maryland  in  that  the  new  professor  is  obligated 
to  devote  a  certain  number  of  hours  of  each  day  to  teaching  pur- 
poses. Dr.  Pincoffs  is  a  gTaduate  of  the  Johns  Hopkins  University 
and  a  veteran  of  the  Great  War  in  which  he  served  with  great  dis- 
tinction, his  work  meriting  the  commendation  of  his  superiors. 
He  was  also  for  some  time  a  resident  physician  in  the  Municipal 
Hospital  at  Bay  View.  He  is  well  trained,  and  we  feel  sure  is  a 
distinct  acquisition  to  the  teaching  force  of  the  University.  "The 
Bulletin"  bespeaks  for  him  much  success  and  its  co-operation  in 
making  his  administration  both  profitable  and  creditable.  Doctor 
Pincoffs'  appointment  came  as  a  result  of  Doctor  Gordon  Wilson 
refusing  to  serve  as  the  head  of  the  medical  department  any 
longer.  "The  Bulletin"  is  sorry  that  Dr.  Wilson  saw  fit  to  relin- 
quish the  leadership  of  this  department,  and  desires  to  express  to 
him  on  behalf  of  its  readers  its  sincere  appreciation  of  his  long, 
faithful,  and  capable  service  to  the  University  of  Maryland.  It  is 
glad  to  announce,  however,  that  the  institution  will  not  entirely 
lose  the  signal  attainments  of  Dr.  Wilson  in  that  he  will  remain  a 
member  of  the  teaching  body  and  continue  to  deliver  in  his  cff'ect- 
ive  and  inimitable  way  a  course  of  lectures  as  of  yore. 

TO  OUR  OLDEST  LIVING  MEDICAL  ALUMNUS,  GREETINGS- 
DOCTOR  CART  B.  GAMBLE,  CLASS  OF  1846. 

For  a  long  time  "The  Bulletin"  has  been  under  the  erroneous 
impression  that  the  oldest  living  alumnus  of  the  University  of 
Maryland's  Medical  Department  was  Doctor  John  J.  R.  Krozer, 
class  of  1848,  who  died  February  22,  1921.  At  that  time  there 
was  a  graduate  living  who  antedated  Dr.  Krozer's  graduation  by 
two  years — ^Dr,  Gary  B.  Gamble,  Sr.,  class  of  1846.  Though  96 
years  old,  it  is  stated  that  Dr.  Gamble's  mind  is  still  unclouded. 


18 

He  is  the  son  of  Col.  Robt.  Gamble,  of  Gamble's  Hill,  Richmond, 
Va.,  and  Letitia  Breckinridge,  a  descendant  of  Gen.  James  Breck- 
enridge,  candidate  for  the  Presidency  against  Abraham  Lincoln, 
and  the  father  of  Dr.  Gary  B.  Gamble,  Jr.,  class  of  1887,  a  pro- 
fessor of  medicine  in  the  University  of  Maryland  and  ex-Major, 
M.  C.,  TJ.  S.  A.,  in  the  Great  War.  Dr.  Gamble,  Sr.,  was  born  at 
Grove  Hill,  Botetourt  County,  Va.,  in  1825.  When  but  one  year 
old  Dr.  Gamble's  father  moved  to  Florida.  At  ten  years  of  age  he 
was  sent  to  a  school  in  Richmond,  going  thence  to  Washington  and 
Lee  College,  then  to  the  University  of  "Virginia,  where  he  was  grad- 
uated with  the  class  of  1845.  He  then  entered  the  Medical  De^ 
partment  of  the  University  of  Maryland,  graduating  with  the 
degree  of  M.  D.  in  1846.  Soon  thereafter  he  returned  to  Florida, 
where  he  practiced  his  profession  until  the  outbreak  of  the  Civil 
War,  when  he  joined  up  with  the  Confederacy  and  was  assigned 
to  the  First  Florida  Volunteer  Regiment  as  surgeon,  with  the  rank 
of  Major.  At  the  battle  of  Shiloh  he  was  captured  by  the  Yankees, 
but  was  later  exchanged  and  rejoined  the  Confederate  Army,  in 
which  he  served  until  the  close  of  the  struggle.  After  the  war  he 
came  to  Baltimore,  where  he  practised  medicine  with  much  success 
and  credit  to  himself  and  his  Alma  Mater  until  the  early  years 
of  the  present  century.  Since  his  retirement  he  has  moved  to  Re- 
lay, Maryland,  where  he  makes  his  home  with  a  grandson,  Edward 
B.  Lowndes.  "The  Bulletin"  extends  to  Doctor  Gamble  its  most 
sincere  wishes  and  congratulations  on  a  life  so  ripe  with  experi- 
ence and  good  deeds,  and  hopes  that  he  will  be  spared  for  many 
years  to  come. 


19 

ITEMS 

Amongst  the  Fellows   of  the  American   College   of   Surgeons 
are: 

William  H.  Arthur,  M.D.,  2130  Le  Roy  Place,  Washington,  D.  C, 
Colonel  M.  C,  U.  S.  Army,  retired;  Howard  Elmer  Ashbury, 
Phar.G.,  M.D.,  1903,  810  St.  Paul  Street,  Baltimore,  Md.;  W.  Wayne 
Babcock,  M.D.,  P.  &  S.  1893,  Professor  of  Surgery  and  Clinica*l 
Surgery,  Temple  University,  2033  Walnut  Street,  Philadelphia, 
Pa.;  Charles  Bagby,  Jr.,  A.B.,  M.D.,  class  of  1904,  Associate  in 
Experimental  Neurology,  Johns  Hopkins  University,  the  Latrobe 
Apartments,  Baltimore,  Md.;  Julian  Meredith  Baker,  B.Sc,  M.D., 
class  of  1879,  503  Main  Street,  Tarboro,  N.  C-;  Edgar  Garrison 
Ballenger,  M.D.,  class  of  1901,  Associate  Professor  of  Genito- 
urinary Diseases,  Emory  University,  805  Healey  Building,  At- 
lanta, Ga.;  Charles  W.  Banner,  D.D.S.,  M.D.,  class  of  1899,  Banner 
Building,  Greensboro,  N.  C;  Frank  L.  Barnes,  M.D.,  P.  &  S., 
1896,  1408  Rosalie  Avenue,  Houston,  Texas;  Robert  Parke  Bay, 
M.D.,  class  of  1905,  Professor  of  Oral  Surgery,  University  of 
Maryland,  1800  N.  Charles  Street,  Baltimore,  Md.;  John  J.  Bell, 
M.D.,  P.  &  S.,  1901,  661  W.  Eighth  Street,  Erie,  Pa.;  John  Mc- 
Farland  Bergland,  B.Sc,  John  Hopkins  University,  1904,  Associ- 
ate in  Obstetrics,  University  of  Maryland,  4  W.  Biddle  Street, 
Baltimore,  Md.;  Daniel  Albert  Berndt,  M.D.,  P.  &  S.,  1896,  1304 
Gallia  Avenue,  Portsmouth,  Ohio;  Edward  J.  Bernstein,  M.D., 
class  of  1887,  507  Fine  Arts  Building,  Detroit,  Mich;  William  N. 
Bisphan,  class  of  1897,  Colonel  M.  C,  U.  S-  Army,  Washington, 
D.  C;  Dougal  Bissell.  B.Sc,  M.D.,  class  of  1888,  219  W.  Seventy- 
ninth  Street,  New  York  City;  Hugh  Ratchford  Black,  A.M.,  M.D., 
class  of  1883,  Spartanburg,  S.  C;  Edward  Maurice  Blackwell, 
M.D.,  class  of  1890,  Commander,  M.  C,  U.  S.  Navy,  Washington, 
D.  C;  Charles  French  Blake,  P.  &  S.,  1893,  Professor  of  Proc- 
tology, University  of  Maryland,  20  E.  Preston  Street,  Baltimore, 
Md.;  Herbert  C.  Blake,  M.D.,  B.M.C.,  1905,  Associate  Professor 
of  Surgery,  University  of  Maryland,  1014  W.  Lafayette  Avenue, 
Baltimore,  Md.;  Rupert  Blue,  M.D.,  D.Sc,  D-P.H.,  class  of  1892. 
United  States  Public  Health  Service,  Washington,  D.  C,  formerly 
Surgeon  General,  U.  S.  P.  H.  S.;  James  Bordley,  Jr.,  M.D.,  class 
of  1896,  330  N.  Charles  Street,  Baltimore,  Md.;  John  B.  Boucher, 
M.D.,  p.  &  S.,  1894,  25  Charter  Oak  Avenue,  Hartford,  Conn.;  Wil- 
liam St.  Clair  Bowen,  M.D.,  class  of  1888,  Clinical  Professor  of 
Obstetrics,  George  Washington  University,  The  Farragut,  Wash- 
ington, D.  C;  Charles  Emil  Brack,  Phar.G.,  M.D.,  P.  &  S.,  1895, 
Professor  of  Clinical  Obstetrics,  University  of  Maryland,  500  E. 
Twentieth  Street,  Baltimore,  Md.;  Hugh  Brent,  M.D.,  class  of 
1903,  Associate  Professor  of  Gynecology,  University  of  Mary- 
land, 16  E.  Chase  Street,  Baltimore,  Md.;  Roger  Brooke,  M.D., 
B.M.C.,  1900,  Colonel,  M.  C,  U.  S.  Army,  Washington,  D.  C; 
George  Corbin  Bryan,  M.D.,  B.M.C.,  1896,  217  Baker  Building, 
Walla  Walla,  Washington;    George  McClellan   Burroughs,  M.D., 


20 

B.M.C.,  1900,  5  Broad  Street,  Danielson,  Conn.;  Arthur  Parker 
Butt,  M.D.,  P.  &  S.,  1895,  205  Randolph  Avenue,  Elkins,  W.  Va.; 
Harry  Francis  Byrnes,  M.D.,  B.M.C.,  1904,  4  Chestnut  Street, 
Springfield,  Mass. 

It  will  be  pleasing  to  his  friends  wherever  located  to  know  that 
Doctor  Henry  L.  P.  ISTaylor,  a  veteran  in  point  of  service  to  hu- 
maility,  is  still  actively  engaged  in  the  practice  of  his  profession. 
Doctor  Naylor  is  a  graduate  of  the  class  of  1860,  It  is  given  to 
but  few  doctors  to  serve  man  over  a  period  .of  sixty-one  years. 
Snch  is  Doctor  IS^aylor's  record.  And  be  it  to  his  everlasting  glory 
he  has  always  kept  abreast  of  the  times.  He  has  seen  medicine 
pass  through  many  fads  and  fancies  and  from  one  basic  discovery 
to  another.  Those  which  proved  their  usefulness  he  adopted.  We 
are  glad  to  state  that  today  his  mind  is  as  active  as  ever  and  that 
he  is  still  as  of  yore  practicing  his  profession  with  credit  both  to 
himself  and  his  alma  mater. 

Doctor  Kenneth  B.  Jones,  class  of  1911,  has  assumed  charge  of 
the  University  Hospital,  as  superintendent,  vice  Dr.  Harry  M. 
Stein,  class  of  1914,  superintendent  during  the  last  three  years, 
resigned  to  enter  private  practice  in  Baltimore.  Dr.  Stein  will 
limit  his  practice  to  internal  medicine.  He  is  well  prepared,  and 
was  a  capable,  conscientious  and  most  acceptable  superintendent. 
The  best  wishes  of  "The  Bulletin"  go  with  him  in  his  new  under- 
taking. 

Doctor  Robert  L.  Felts,  class  of  1898,  is  located  at  Durham, 
!N^.  C.  He  is  at  present  attending  the  medical  and  pediatric  clinics 
at  the  University  Hospital. 

Doctor  Milton  R.  Walter  is  located  at  167  West  Seventy-first 
Street,  jN'ew  York  City. 

Doctor  Howard  J.  Maldeis,  class  of  1903,  has  resigned  as  visit- 
ing pathologist  to  the  University  Hospital.  He  has  opened  a 
laboratory  of  clinical  pathology  at  605  Park  Avenue,  Baltimore, 
Md.  He  is  prepared  to  do  all  sorts  of  blood  work,  urine  and  gas- 
tric analyses  and  tissue  examination. 

Doctor  A.  L.  Fehsenfeld,  class  of  1909,  and  Mrs.  Fehsenfeld,  of 
Baltimore,  are  receiving  the  congratulations  of  their  friends  on 
the  birth  of  a  baby  boy. 

Doctor  'N.  de  Cadorna,  class  of  1920,  is  serving  as  a  medical 
interne  at  the  Maryland  General  Hospital. 

Doctor  John  William  Metcalf,  class  of  1920,  is  a  surgical  resi- 
dent in  the  Maryland  General  Hospital. 

Doctor  George  LeRoy  Wissig,  class  of  1920,  is  a  gynecological 
resident  in  the  Maryland  General  Hospital. 

Doctor  Lynn  H.  Brumback,  class  of  1920,  is  a  gynecological 
resident  in  the  University  Hospital. 


21 

_  Doctor  John  G.  M.  Eeese,  class  of  1920,  is  the  resident  obstet- 
rician in  the  University  Hospital.    • 

Doctor  Jack  Hundley,  late  resident  gynecologist  in  the  Uni- 
versity Hospital,  has  opened  offices  at  1009  Cathedral  Street,  Balti- 
more. He  limits  his  practice  to  gynecology  and  abdominal  sur- 
gery. 

DoctoT  Zeb.  Hooper,  late  surgical  resident  in  the  University 
Hospital,  has  returned  to  his  home  in  North  Carolina. 

Doctor  W.  F.  Sappington,  class  of  1901,  has  been  commissioned 
a  Major  in  the  M.  C.,  of  the  United  States  Army. 

Doctor  John  C.  Woodland,  class  of  1915,  Captain  M.  C,  U. 
S.  A.,  is  stationed  at  Camp  Meade. 

Doctor  Everett  Le  Compte  Cook,  class  of  1914,  Captain,  M.  C, 
U.  S.  A.,  is  stationed  in  Panama,  He  was  a  recent  visitor  to  the 
University  Hospital  when  on  leave  of  absence. 

Doctor  Henry  A.  ]N"aylor,  class  of  1900,  is  president  of  the 
Baltimore  County  Medical  Society. 

Doctors  J.  C.  Brogden  and  C.  C.  Hoke  have  opened  offices  at 
Y36-37  Mayo  Building,  Tulsa,  Okla. 

Doctor  FitzEandolph  Winslow,  class  of  1906,  has  removed  from 
Baraboo,  Wis.,  to  Hayden,  Arizona,  where  he  is  engaged  in  the 
practice  of  surgery. 

Doctor  William  J.  Coleman,  class  of  1908,  late  Lieut-Colonel, 
U.  S.  Army,  and  formerly  medical  superintendent  at  the  Univer- 
sity Hospital,  has  been  re-elected  medical  superintendent  of  the 
Maryland  General  Hospital. 

Doctor  George  Perry  Eoss,  class  of  1915,  late  Captain,  U.  S. 
Army,  has  located  at  Skaneateles,  New  York,  where  he  is  engaged 
in  the  practice  of  his  profession. 

Doctor  Arthur  M.  Shipley,  class  of  1902,  late  Lieut.-Colonel, 
M.  C,  U.  S.  Army,  has  been  cited  by  Surgeon  General  Ireland, 
M.  C,  U,  S.  A,,  and  recommended  for  the  Distinguished  Service 
Medal  for  service  rendered  in  France  as  director  of  the  surgical 
department  in  Evacuation  Hospital  No,  8,  It  is  both  satisfying 
and  gratifying  to  his  many  friends  to  hear  that  Dr.  Shipley's 
service  has  been  deemed  worthy  of  this  recognition.  It  is  said 
that  Dr,  Shipley's  teams  were  the  best  organized  of  any  of  the 
surgical  teams  in  the  American  Expeditionary  Force. 

Doctor  W.  S.  Eankin,  class  of  1901,  Secretary  of  the  North 
Carolina  State  Board  of  Health,  was  the  speaker  at  the  De  Lamar 
course  lecture  at  Johns  Hopkins  School  of  Hygiene  and  Public 
Health,  April  11,  1921.  His  subject  was  "Certain  Important 
Principles  of  State  Health  Administration."  Doctor  Eankin  has 
attained  an  enviable  position  amongst  the  health  officials  of  the 


22 

country.     He  is  a  young  man  of  extraordinary  ability  and  reflects 
credit  upon  his  Alma  Mater. 

It  will  be  gratifying  to  his  friends  to  hear  that  Doctor  F.  W. 
Rankin,  class  of  1909,  is  considered  one  of  the  most  skilled  assist- 
ants that  has  served  at  the  Mayo  Clinic. 

The  General  Alumni  Association  of  the  University  of  Maryland 
held  its  annual  banquet  May  28,  1921,  at  the  Hotel  Southern, 
Baltimore.  This  in  all  probability  will  be  the  last  public  func- 
tion of  this  organization,  as  it  is  proposed  to  fuse  all  of  the 
alumni  associations  of  the  University  into  one  body,  to  be  known 
as  the  Alumni  Association  of  the  University  of  Maryland.  This 
is  as  it  should  be.  There  has  always  been  too  much  division  of 
interests  at  the  University,  and  the  reorganization  of  the  various 
alumni  associations  into  one  component  body  is  a  step  in  the  right 
direction.  A  school  is  wh^t  its  alumni  make  it,  no  more,  no  less. 
A  strong,  active  alumni  association  means  a  strong  University  of 
Maryland ;  a  weak,  inactive  alumni  association  or  series  of  alumni 
associations  means  a  weak,  struggling  University  of  Maryland.. 
Realizing  that  the  several  departments  have  interests  peculiar  to 
the  special  school,  the  plan  of  reorganization  will  in  all  probability 
take  the  form  of  a  series  of  chapters  for  the  several  departments, 
with  a  strong  central  body  directing  the  whole.  At  any  rate,  the 
officers  elected  at  this  meeting  are  to  hold  office  only  until  some 
sort  of  an  arrangement  is  consummated  when  the  General  Alumni 
Association  will  cease  to  exist.  It  has  done  a  good  work  in  that  it 
has  shown  the  necessity  of  one  association  for  all  of  the  schools. 
Its  work  is  accomplished.  It  must  give  way  for  changed  times 
and  changed  conditions. 

Doctor  William  Royal  Stokes,  Professor  of  Bacteriology  in  the 
University  of  Maryland  and,  since  1896,  City  and  State  Bac- 
teriologist, is  recovering  from  a  nervous  breakdown.  Here's  hop- 
ing that  he  will  soon  be  well. 

Doctor  L.  A.  Riser,  class  of  1908,  is  assistant  to  the  State 
Health  Officer,  South  Carolina,  and  is  located  in  Columbia,  S.  C. 
He  writes  that  Doctor  Roy  Finney,  class  of  1920,  made  the  high- 
est grade  of  any  of  the  participants  before  the  State  Board  of 
Medical  Examiners  of  South  Carolina  at  the  Fall  1920  examina- 
tion, and  Doctor  Paul  E.  Knotts,  class  of  1920,  was  second.  He 
also  states  that  Doctor  Finney's  grade  is  the  highest  ever  made 
before  the  State  Board  of  South  Carolina.  "The  Bulletin"  de- 
sires to  extend  its  sincerest  congratulations  to  these  two  men  who 
so  nobly  have  upheld  the  prestige  of  their  Alma  Mater. 


23 

The  graduates  of  the  1921  class,  University  Hospital  Training 
School  for  JSTurses,  are: 

Mary  Belle  McDaniel Maryland  Julia  Rebecca  Smith Maryland. 

Zadieth  Violet  Reese Maryland.  Susan  Pauline  Neady Penna. 

Anna  Elizabeth  Woods.  .Maryland.  Christine  Minnis Penna. 

Louise  Lee  Batemen. ..  .Maryland.  Ruby  Lee  Reister No.  Car. 

Mary  Cutter  Fisher Maryland.  Claribel    Hampton No.  Car. 

Norma  Lavada  Gaver Maryland.  Jessie  Geraldine  Rhodes.  ..No.  Car. 

Ruth  Elizabeth  Gorman. Maryland.  Kate  Womack  Hogshead.  ..No.  Car. 

Helen  Margaret  Childs.  .Maryland.  Helen  Eugenie  Reamy Virginia. 

Isabelle  Jean  Hanna Maryland.  Blanche  Lee  Martin No.  Car. 

Doctor  A.  L.  Wilkinson,  class  of  1903,  is  Secretary  of  the  Balti- 
more County  Medical  Society. 

Doctor  H.  0,  Eeik,  class  of  1891,  is  director  of  the  Department 
of  Ophthalmology  and  Oto-Laryngology  in  The  American  Insti- 
tute of  Medicine,  ISTew  York. 

The  following  is  the  report  of  the  Woman's  Auxiliary  Board 
for  the  the  past  year : 

Swiftly  as  a  feather  falling  from  an  eagle's  flight  has  sped 
away  the  last  twelvemonth,  and  today  the  Woman's  Auxiliary 
Board  stands  facing  a  New  Year,  for  which  the  mysteries  of  Fate 
and  Time  hold  in  their  silent  laps  the  destinies  of  the  members. 
Happiness  we  desire  in  abundant  measure,  but  that  is  not  all. 
What  we  should  more  earnestly  crave  is  the  life  of  the  soul; 
for,  as  has  been  said  by  a  great  writer,  "It  is  not  at  all  a  question 
of  the  quantity  of  what  we  do,  but  of  the  quality,"  and  if  our 
hearts  are  full  of  the  light  of  God,  it  shall  be  ever  well  with  us. 

Behind  the  Woman's  Auxiliary  Board  lies  a  year  of  superb 
endeavor,  of  extended  usefulness,  of  new  fields  conquered  and 
occupied. 

Our  membership  has  been  increased  to  160;  our  views,  our 
visions,  have  been  enlarged;  our  hearts  opened  still  more  widely 
to  the  cry  of  the  helpless  and  the  poor. 

May  I  not  recite,  then,  some  of  the  things  that  have  been  done? 

New  lights  have  been  installed  all  through  the  Free  Wards  at 
a  cost  of  $175.00.  The  Children's  Clinic,  where  thousands  of 
babies  are  saved,  is  headed  in  the  Woman's  Department  by  two 
of  our  members,  to  whom  the  physicians  in  charge  give  every 
praise  for  efficiency.  In  the  larger  general  clinic,  where  thou- 
sands are  helped  back  to  life,  one  member  heads  the  women 
workers  and  many  others  work  under  her.  Two  rummage  sales, 
realizing  over  $550.00,  under  the  leadership  of  another  member; 
still  another,  whose  health  prevents  her  taking  an  active  part  in 
the  work  of  the  Board,  has  given  $10,000.00,  the  interest  from 
which  is  to  be  used  in  work  throughout  the  Hospital;  while  still 
another  member  has  interested   a   great   woman's   organization. 


24 

The  Daughters  of  the  American  Revolution,  in  establishing  a  bed 
in  the  Maternity  Ward  at  a  cost  of  $1,000.00.  Many  card  parties 
and  evening  affairs  have  been  given  by  various  members,  which 
have  swelled  the  coffers  of  the  treasury  and  have  been  expended 
in  deeds  of  mercy.  A  beautiful  custom  instituted  the  past  year, 
and  which  I  hope  will  always  be  continued,  is  the  presentation 
to  an  honor  nurse  of  the  graduating  class  of  a  class  pin  as  a 
recognition  of  her  excellence,  and  I  would  recommend  that  the 
Board  draw  ever  closer  to  the  nurses,  and  help  them  in  every 
way  in  their  beautiful  work.  Twice  a  year  $6000  is  donated  to 
aid  in  keeping  up  the  linen  in  the  Free  Wards.  The  Monthly 
Committee  all  through  the  year  have  scattered  comforts,  dainties, 
books  and  magazines  among  the  convalescent  patients,  and  at  the 
Xmas  Tide  decorated  the  Hospital,  filled  trees  with  gifts  and 
given  an  entertainment  and  banquet  to  all. 

Indeed,  it  is  not  too  much  to  say  that  no  call  for  help,  no 
request  for  assistance,  has  been  disregared.  Even  $10000  has 
been  put  aside  to  purchase  the  Rockefeller  serum  to  be  used  in 
desperate  cases  of  pneumonia. 

And  then  in  the  Autumn,  as  a  culmination,  came  the  drive  for 
funds  for  the  Nurses'  Home,  and  so  hearty  and  generous  was  the 
response  of  the  Woman's  Auxiliary  Board  that  often  in  the  weekly 
reports  their  committees  exceeded  in  amounts  brought  in  those 
of  their  male  associates. 

In  addition  to  the  beautiful  new  Nurses'  Home  which  the 
Board  expects  to  do  much  in  furnishing,  we  are  hoping  for  a 
Child's  Hospital  built  from  the  church  across  the  way,  and  I  beg 
that  each  and  every  member  of  the  Board  will  feel  a  keen 
responsibility,  and  will  throw  herself  into  the  work  for  these 
two  magnificent  additions  with  all  the  capability  and  enthusiasm 
that  lead  to  success. 

And  now  to  you,  dear  members  of  the  Woman's  Auxiliary 
Board,  I  extend  my  thanks  and  express  my  gratitude  for  the 
unvarying  courtesy,  unfailing  co-operation  and  charming  friend- 
ship which  you  have  ever  shown  me  since  I  have  been  your 
President.  The  two  years  have  passed  all  too  swiftly  and  have 
indeed  been  those  of  pleasure  and  satisfaction,  and  I  am  proud 
to  hand  over  to  my  successor  a  Board  larger  in  numbers,  more 
extended  in  usefulness,  more  eager  in  good  works,  than  has  ever 
before  been  the  lot  of  the  Woman's  Auxiliary  Board  of  the  Uni- 
versity Hospital  of  Maryland. 

Florence  Maclntyre  Tyson 

Mrs.  Frederic  Tyson,  251  Preston  St.,  West, 
January  7th,  1921 


25 


At  the  Annual  Commencement,  held  at  the  Lyric  on  June  1, 
1921,  the  following  men  were  granted  the  degree  of  M.  D. : 

John  Forsyth  Aubrey.  .  .Maryland.     Thos.  Rutter  O'Rourk Maryland. 

Francis  Lucian   Badagliacca.  .N.  J.    Frank  Anthony  Pacienzo.  .Maryland. 
Bruce  Barnes N.  J.    Moses  Paulson Maryland. 


Carl  Fisher  Benson Maryland. 

John  Ralph  Bernardo. .  .Delaware. 

Vincent  Bonfiglio Maryland. 

Jogesh  Chandra  Bose,  B.S Md. 

Earl  Edgar  Broadrup.  .  .Maryland. 

Andres  G.  Castro Costa  Rica. 

Oscar  G.  Costa Porto  Rico. 

Samuel  Hearn  Culver.  .  .Delaware. 

Herman  Jacob  Dorf New  York. 

C.  F.  Fisher West  Virginia. 

Daniel  Sebastian  Fisher. Maryland. 

Charles  J.  Foley Maryland. 

Joseph  P.  Franklin,  B.A.,  Alabama. 

Leon  Freedom. Maryland. 

Willetts  "Walton  Gardner„A.B..N.  Y. 

Kyle  Wood  Golley Maryland. 

J.  Stanley  Grabill Maryland. 

John  Willis  Guyton Maryland. 

Cyrus  Eugene  Hawks Virginia. 

Legan  Henry  Hobgood Mass. 

Albert  Salomon  Hoheb,  Porto  Rico. 

Julius  I.  Holofcener Maryland. 

Albert  Jaffe. Maryland. 

Baxter  S.  John Virginia. 

Vincent  Vernon  Joska.  ..Maryland. 
Geo.  Richardson  Joyner.  .Virginia. 
Daniel  Francis  Keegan,  B.A.,  Conn. 
Richard  Joseph  Kemp..  .Maryland. 

Louis  Lass.  . New  York. 

Benjamin  Luban.  . New  York. 

Arley  Von  McCoy,  A.B West  Va. 

Ezequiel  Martinez Porto  Rico. 

Stanley  Wm.  Matthews .  .North  Car. 


Edgar  Allan  Poe  Peters,  B.S Ky. 

Harold  C.  Pillsbury.  . . . . .  .Maryland. 

Ralph  Johnson  Plyler,  A.B. . .No.  Car. 

Joseph  Pokorny. Maryland. 

Norberto  A.  Quinones. ..  .Porto  Rico. 
Francis  A.  Reynolds.  .Massachusetts. 

Ferdinand  A.  Reis Maryland. 

Harold  A.  Romilly Virginia. 

James  Barry  Ryon,  A.B.. .  .Maryland. 

Fred.  C.  Sabin New  York. 

Phillip  J.  Savage Connecticut. 

Jesmond  Wm.  Schilling Penna. 

Thomas  Walter  Seay Virginia. 

Solomon  Sherman Maryland. 

Elliott  Walter  Shircliff Maryland. 

Felix  S.  Shubert Pennsylvania. 

John  Augustus  Skvarla,  New  Jersey. 
Jacob  Long  Sowers,  B.S..  .North  Car. 

S.  Gordon  Stone Ohio. 

John  Valentine  Szczerbicki Md. 

Stanley  J.  Tilghman Marj'land. 

Louis  Michael  Timko,  Pennsylvania. 
Herman  Ernest  Wangler,  New  York. 

Edwin  E.  Ward Maryland. 

Wm.  Ferdinand  Weinkauf,  Michigan. 

George  Edward  Wells Maryland. 

Paul  Foreman  Wiest.  .West  Virginia. 
James  Herbert  Wilkerson,  Maryland. 

Mortimer  H.  Williams Virginia. 

W.  Wellford  Wilson,  Phar.D Md. 

James  Clinton  Wolfe. . .  .New  Jersey. 
Leslie  Arno  Yeager,  B.S.,  Maryland. 


26 

MARRIAGES 

Doctor  Walter  D.  Wise,  Clinical  Professor  of  Surgery  in  the 
University  of  Maryland,  was  married  July  27,  1921,  to  Mrs.  Hugh 
McMillan,  of  Colorado  Springs,  Colorado. 

DEATHS 

Doctor  James  Foster  Means,  Claremore,  Okla.,  B.  M.  C,  class 
of  1892,  Captan,  M.  C,  U.  S.  A.,  died  July  9,  1921,  of  aortitis, 
aged  55  years. 

Doctor  Howard  M.  Kemp,  of  Bloomington,  Maryland,  class  of 
1881,  died  suddenly  March  14,  1921,  of  heart  trouble  while  on  a 
professional  visit  to  a  patient.  Doctor  Kemp  was  bom  at  Bloom- 
ington 62  years  ago,  and  practiced  there  35  years.  He  served 
several  terms  in  the  Maryland  House  of  Delegates  as  a  member 
from  Garrett  County. 

Doctor  Louis  C.  Carrico,  of  Bryantovni,  Maryland,  class  of 
1885,  died  suddenly  March  13,  1921,  of  heart  disease.  He  was 
one  of  Charles  County's  most  pi  eminent  physicians,  and  for  years 
had  been  recognized  as  one  of  the  Democratic  leaders  of  that 
county.  He  was  60  years  old.  He  was  born  in  Charles  County, 
and  was  educated  at  Charlotte  Hall  Academy  and  Rock  Hall  Col- 
lege. He  was  graduated  in  medicine  from  the  University  of 
Maryland  and  began  the  practice  of  medicine  in  1885.  Previous 
to  that  he  had  been  a  school  teacher.  He  was  School  Commis- 
sioner for  Charles  County  from  1888  to  1892.  In  1891  he  was 
elected  a  member  of  the  House  of  Delegates  of  the  Maryland  Legis- 
lature, and  in  1893  to  the  State  Senate.  Doctor  C.  P.  Carrico,  of 
Cecil  County,  is  a  brother. 

Doctor  J.  Horace  Jenkins,  class  of  1901,  of  Elkton,  Maryland, 
died  August  22,  1921,  aged  44.  He  had  been  ill  a  week  and  was 
removed  to  a  hospital  in  Wilminigton,  where  he  died.  He  was  a 
native  of  Georgia.  After  graduating  he  returned  to  his  native 
State,  later  to  remove  to  Elkton, 

Doctor  John  S.  Green,  class  of  1882,  one  of  the  leading  physi- 
cians of  Baltimore  County,  died  suddenly  August  2,  1921,  of  heart 
disease.  Doctor  Green  was  64  years  old.  Doctor  Maurice  Green, 
of  Hamilton,  and  Doctor  John  S.  Green,  Jr.,  are  sons.  Since 
graduating  in  1882,  Doctor  Green  has  practiced  his  profession  at 
Glenarm.  He  was  wide  and  favorably  known,  a  conscientious 
practitioner,  a  true  and  loyal  friend  to  the  University  of  Mary- 
land. 

Doctor  John  G.  Jay,  class  of  1871,  of  Baltimore,  died  April  1, 
1921,  of  heart  disease,  aged  72.    Doctor  Jay  was  born  in  Harford 


27 

County.  After  graduating  from  Delaware  College,  he  studied 
medicine  at  the  University  of  Maryland,  graduating  with  the 
class  of  1871.  He  then  became  associated  with  the  late  Doctor 
Christopher  Johnston.  For  many  years  he  was  professor  of  an- 
atomy and  surgery  at  the  Woman's  Medical  College,  Baltimore. 
Later  he  became  assoeiae  professor  of  surgery  and  then  clinical 
professor  of  surgery  and  finally  emeritus  clinical  professor  of  sur- 
gery in  the  University  of  Maryland.  Doctor  Jay  is  said  to  have 
performed  the  first  successful  Caesarian  section  in  Maryland.  Dur- 
ing the  Spanish-American  War,  Dr.  Jay  was  chief  surgeon  to  the 
Fifth  Maryland  Eegiment,  Infantry,  United  States  Volunteers. 

Doctor  George  Glanville  Rusk,  class  of  1867.  of  Baltimore, 
died  April  14,  1921,  of  pneumonia,  aged  74.  Dr.  Rusk  practiced 
medicine  for  many  years  in  the  eastern  section  of  the  city,  where 
he  was  widely  and  favorably  known. 

Doctor  Reuben  Saunders  Toombs,  of  Memphis,  Tenn.,  Wash- 
ington University,  class  of  1866,  a  former  secretary  of  the  Miss- 
issippi State  Medical  Association  and  one  of  the  founders  of  the 
University  of  Tennessee,  and  professor  of  materia  medica,  clin- 
ical medicine  and  medical  ethics  in  the  University  of  Tennessee 
until  1918,  as  well  as  a  Confederate  veteran,  died  July  15,  1921, 
at  Lexington,  Ky.,  aged  77. 

Doctor  Logan  Lindsay  Banner,  Castlewood,  Va.,  P.  &  S.,  class 
of  1884,  died  June  29,  1921,  from  general  paresis,  aged  63.  From 
1897  to  1905  he  served  as  a  member  of  the  United  States  Board 
of  Medical  Examiners  for  Pensioners. 

Doctor  J.  E.  Foscue,  class  of  1901,  of  Jamestown,  IST.  C,  died 
suddenly  November  9,  1920,  while  on  a  professional  call. 

Doctor  Leo  Karlinsky,  class  of  1906,  of  Baltimore,  died  June 
13,  1921,  after  an  illness  of  five  days.  He  was  36  years  of  age 
and  a  resident  of  Baltimore  all  of  his  life. 

Doctor  Joseph  S.  Raborg,  class  of  1867,  of  1202  Mt.  Royal 
Avenue,  Baltimore,  died  June  12,  1921. 

Doctor  Charles  R.  Foutche,  of  Berkeley  Springs,  W.  Va.,  P.  & 
S.,  class  of  1885,  died  April  12,  1921,  of  a  complication  of  dis- 
eases, aged  59.  After  graduating  he  first  located  at  Parsons,  W. 
Va.,  but  ten  years  ago  moved  to  Berkeley  Springs. 

Doctor  Edward  P.  McDevitt,  class  of  1875,  of  2432  :N"orth 
Charles  Street,  Baltimore,  died  March  8,  1921,  of  heart  disease, 
aged  66. 


28 
BOOK  REVIEW 

The  Anatomy  of  the  Nervous  System,  from  the  Standpoint  of 
Development  and  Function.  By  Stephen  W.  Ranson,  M.D.,  Ph.D., 
Professor  of  Anatomy  in  Northwestern  University  Medical  School, 
Chicago.  Philadelphia  and  London:  W.  B.  Saunders  Company, 
1920;  cloth;  $6.50  net.  During  the  last  twenty-five  years  much 
work  has  been  done  in  clearing  up  obscure  points  in  the  anatomy 
of  the  nervous  system.  These  investigations  have  added  not  only 
to  our  knowledge  of  the  structure  of  this  system,  but  also  of  its 
physiological  and  pathological  manifestations.  The  above  men- 
tioned book  was  projected  with  the  idea  of  creating  greater  inter- 
est as  well  as  pleasure  in  the  study  of  nerve  anatomy  by  inter- 
spersing amongst  the  pages  its  relationship  to  physiological  and 
pathological  processes.  Everywhere  the  book  teems  with  illustra- 
tions between  the  normal  and  abnormal  anatomy  and  the  related 
problems  of  physiology  and  pathology.  By  stressing  this  feature 
and  emphasizing  the  practical  applications  to  which  a  thorough 
knowledge  of  the  anatomy  can  be  applied  in  the  solving  of  neuro- 
logical problems  more  interest  should  be  aroused  in  the  study  of 
an  otherwise  dull  subject.  Dr.  Ranson  is  surely  to  be  congratu- 
lated upon  presenting  a  purely  laboratory  and  basic  subject  in 
such  an  attractive  garb.  The  tone  of  the  book  is  conservative,  the 
language  is  simple,  direct,  the  style  is  excellent,  the  illustrations 
are  appropriate  and  well  executed — all  points  which  should  com- 
mend it  to  the  good  graces  of  the  student  and  general  practitioner 
desirous  of  gaining  a  working  knowledge  of  neurologial  anatomy. 
The  author  is  imbued  with  the  right  pedagogical  spirit  when  he 
says  for  physiological  and  chemical  neurology  a  knowledge  of  con- 
duction pathways  and  functional  localization  is  essential,  and 
this  information  can  best  be  acquired  in  connection  with  the  course 
in  anatomic  neurology. 

A  Text-Bool-  on  Pathology.  By  W.  G.  MacCallum,  Professor 
of  Pathology  and  Bacteriologv^  in  the  Johns  Hopkins  Fniversity, 
Baltimore.  Second  Edition,  Thoroughly  Revised.  Pliiladelphia 
and  London:  W.  B.  Saunders  Company,  1920.  Since  the  first 
appearance  of  this  book  important  advances  have  been  madp  in 
certain  fields  of  pathology.  In  order  to  make  this  material  avail- 
able, MacCallum  has  incorporated  these  discoveries  in  a  second 
edition  which  is  just  off  the  press.  The  war  afforded  unexcelled 
opportunities  to  study  pathologically  certain  types  of  disease,  for 
instance,  influenza  and  its  complicating  pneumonia  and  empyema. 
Measles  also  offered  a  fertile  field  for  these  industrious  investi- 
gators, likewise  cerebro-spinal  meningitis,  war  wounds,  the  effects 
of  poison  gas,  those  maladies  that  follow  in  the  wake  of  cold. 


29 

hunger,  starvation.  The  latest  information  on  these  diseases  and 
a  mass  of  other  material  equally  as  important  to  a  proper  apprecia- 
tion of  the  subject  has  been  incorporated  in  the  above  book. 

MacCallum  has  follov^^ed  the  same  plan  in  presenting  the  sub- 
ject as  in  the  earlier  edition.  He  holds  the  view  that  all  disease 
is  due, to  some  injury.  Tumors,  he  admits,  offer  a  stumbling  block 
to  this  plan  inasmuch  as  their  causes  are  still  undetermined.  After 
a  few  chapters  devoted  to  the  general  principles  of  pathology,  the 
writen  then  takes  up  the  various  types  of  injury  and  their  immedi- 
ate and  remote  effects  and  finally  tumors.  With  Chapter  nine 
begins  the  story  of  the  defense  of  the  body  against  injury,  with 
a  complete  description  of  inflammation  and  its  manifestations, 
fever,  immunity,  the  acid-base  equilibrium  of  the  body,  new  growth 
and  tissue  repair,  healing  of  wounds,  illustrative  examples  of 
inflammatory  processes,  destructive  and  reparative  processes,  phys- 
ical, chemical,  etc.  The  author  has  presented  the  subject  in  a 
most  attractive  and  instructive  way.  It  is  a  model  of  concise  and 
clear  thinking.     It  is  amongst  the  best  of  the  modern  pathologies. 

Diagnostic  and  Therapeutic  Techntc.  A  Manual  of  Practical 
Procedures  Employed  in  Diagnosis  and  Treatment.  By  Albert 
S.  Morrow,  M.D.,  late  Lieut-Colonel,  M.  C,  U.  S.  A.,  attending 
surgeon  to  the  City  Hospital  and  to  St.  Bartholomew's  Hospital, 
ITew  York  City ;  consulting  surgeon  to  the  Nassau  Hospital,  Mine- 
ola,  L.  I.  Third  Edition;  Entirely  Reset;  Octavo  of  894  pages, 
with  892  Illustrations,  mos^tly  original.  Philadelphia  and  Lon- 
don: 1921;  Cloth;  $8.00  net.  Morrow's  "Diagnostic  and  Thera- 
peutic Technic"  needs  no  introduction.  The  preceding  volumes 
have  firmly  established  it  as  a  very  useful  and  handy  book  to  have 
around.  Peculiar  as  it  may  seem,  teachers  and  text-books  assume 
in  the  so-called  minor  surgical  procedures  an  unusual  precocious- 
ness  on  the  part  of  students.  They  go  into  the  major  surgical 
operations  to  the  minutest  detail,  but  pass  by  those  things  a  young 
practitioner  will  most  urgently  need  with  a  few  words,  A  thor- 
ough knowledge  of  acupuncture,  venesection,  scarification,  cup- 
ping, leeching,  vaccination,  the  administration  of  diphtheria  anti- 
toxin, are  as  essential  to  the  successful  practice  of  medicine  as  the 
knowledge  of  how  to  perform  an  appendectomy  or  a  herniotomy. 
It  is  this  phase  of  medicine  that  this  book  deals  with.  It  takes  as 
its  scope  such  subjects  as  laryngoscopy,  cystoscopy,  rhinoscopy, 
aspirations,  exploratory  punctures,  infusion  of  normal  salt,  the 
treatment  of  neuralgia  by  injections,  transfusion  of  blood,  passing 
of  sounds,  of  the  stomach  tube,  lavage  of  the  bowel,  enemata,  pes- 
sary therapeutics,  etc. — in  fact,  practically  all  of  the  methods  of 
instrumental  procedures  necessary  to  make  a  complete  examination 


30 

of  the  body  organs.  It  contains  a  complete  description  of  the 
Carrel-Dakin  technic,  including  the  preparation  of  the  solution, 
the  arrangement  of  the  tubes,  and  the  bacterial  examination  of 
the  wound,  the  effects  of,  indications,  methods  of  inducing  and 
complications  of  artificial  pneumothorax,  Bier's  hypermic  treat- 
ment, and  the  diagnosis  and  treatment  of  fistulous  tracts  by  means 
of  bismuth  paste.  It  is  a  most  unusual  book  that  will  be  found 
most  helpful  in  unexpected  emergencies.  It  is  well  written,  con- 
cise and  exceptionally  well  illustrated.  It  gives  us  great  pleasure 
to  heartily  commend  it  to  our  readers. 

Essays  on  Surgical  Subjects.  By  Sir  Berkeley  Moyniham, 
K.C.M.G.,  C.B.,  Leeds,  England.  Illustrated.  Philadelphia  and 
London:  W.  B.  Saunders  Company,  1921.  This  book  contains  a 
number  of  essays  which  have  been  published  from  time  to  time  by 
Sir  Berkeley  Moyniham.  It  contains  the  "Murphy  Memorial 
Oration,"  "The  Bitual  of  a  Surgical  Operation,"  "The  Diagnosis 
and  Treatment  of  Chronic  Gastric  Ulcer,"  "Disappointments  after 
Gastro-Enterostomy,"  "Intestinal  Stasis,"  "Acute  Emergencies  of 
Abdominal  Disease,"  "The  Gifts  of  Surgery  to  Medicine,"  "The 
Surgery  of  the  Chest  in  Relation  to  Retained  Projectiles,"  and 
"The  Most  Gentle  Profession."  Anything  from  the  pen  of  Moyni- 
ham is  more  than  worthwhile.  He  is  one  of  the  outstanding  fig- 
ures in  the  surgical  world  of  the  day,  facile  of  tongue,  pen  and 
knife.  The  profession  is  indeed  fortunate  to  have  under  one  cover 
these  few  essays,  even  though  they  are  but  a  moiety  of  the  con- 
tributions of  the  author  to  the  advancement  of  the  surgical  spe- 
cialty. 

A  Manual  of  Surgery  for  Students  and  Physicians.  By  Francis 
T.  Stewart,  M.D,,  Professor  of  Clinical  Surgery,  Jefferson  Medi- 
cal College;  Surgeon  to  the  Pennsylvania  Hospital,  Fifth  Edi- 
tion, with  590  Illustrations.  Philadelphia,  1921:  P.  Blakiston's 
Son  &  Co.  The  fifth  edition  of  this  "Manual  of  Surgery"  is  the 
posthumous  offering  of  the  lamented  Doctor  Francis  T.  Ste-u'art, 
whose  untimely  death,  on  February  4,  1920,  shocked  his  friends 
and  admirers.  Fortunately,  he  had  practically  finished  the  revi- 
sion of  the  book,  but  it  was  left  to  his  friend.  Doctor  Walter  Estell 
Lee,  to  add  the  experiences  acquired  during  the  Great  War,  and 
to  supervise  the  publication  of  the  work.  The  present  edition  is 
very  much  more  compendious  than  its  predecessor,  and,  really,  has 
outgrown  its  title  of  "A  Manual,"  and  deserves  to  be  called  a  Text- 
Book  on  Surgery.  Not  only  has  the  text  been  entirely  revised,  but 
many  of  the  chapters  have  been  completely  rewritten  and  much 
new  matter  introduced.  It  is  a  safe  and  up-to-date  work,  and  as 
such  we  recommend  it  to  students  and  physicians. 


31 

STATEMENT   OF   THE   OWNERSHIP,  MANAGEMENT,  CIRCULATION, 
ETC.,  REQUIRED  BY  THE  ACT  OF  CONGRESS  OF  AUGUST  24,  1912. 

Title  of  Publication:  "Bulletin  of  the  School  of  Medicine,"  Official  Pub- 
lication of  the  University  of  Maryland. 

Frequency  of  Issue:  Published  four  times  yearly,  at  Baltimore,  Mary- 
land, for  October,  1921. 

State  of  Maryland,  City  of  Baltimore,  ss.: 

Before  me,  a  Notary  Public  in  and  for  the  State  and  City  aforesaid,  per- 
sonally appeared  Nathan  Winslow,  who,  having  been  duly  sworn  accord- 
ing to  law,  deposes  and  says  that  he  is  the  editor  of  the  "Bulletin  of  the 
School  of  Medicine,"  Official  Publication  of  the  University  of  Maryland, 
and  that  the  following  is,  to  the  best  of  his  knowledge  and  belief,  a  true 
statement  of  the  ownership,  management  (and  if  a  daily  paper,  the  circu- 
lation), etc.,  of  the  aforesaid  publication  for  the  date  shown  in  the  above 
caption,  required  by  the  Act  of  August  24,  1912,  embodied  in  section  443, 
Postal  Laws  and  Regulations,  to  wit: 

1.  That  the  names  and  addresses  of  the  publisher,  editor,  managing 
editor,  and  business  managers  are:  Publisher:  University  of  Maryland, 
Baltimore,  Md.  Editor:  Nathan  Winslow,  Baltimore,  Md.  Managing 
Editor:  Nathan  Winslow,  Baltimore,  Md.  Business  Managers:  R.  Wins- 
low, W.  S.  Gardner,  J.  M.  Rowland,  Baltimore,  Md. 

2.  That  the  owners  are  (Give  names  and  addresses  of  individual  own- 
ers, or,  if  a  corporation,  give  its  name  and  the  names  and  addresses  of 
stockholders  owning  or  holding  1  per  cent,  or  more  of  the  total  amount 
of  stock) :  University  of  Maryland  Medical  School. 

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4.  That  the  two  paragraphs  next  above,  giving  the  names  of  the  own- 
ers, stockholders,  and  security  holders,  if  any,  contain  not  only  the  list 
of  stockholders  and  security  holders  as  they  appear  upon  the  books  of 
the  company,  but  also,  in  cases  where  the  stockholder  or  security  holder 
appears  upon  the  books  of  the  company  as  trustee  or  in  any  other  fidu- 
ciary relation,  the  name  of  the  person  or  corporation  for  whom  such 
trustee  is  acting,  is  given;  also  that  the  said  two  paragraphs  contain 
statements  embracing  affiant's  full  knowledge  and  belief  as  to  the  cir- 
cumstances and  conditions  under  which  stockholders  and  security  holders 
who  do  not  appear  upon  the  books  of  the  company  as  trustees,  hold  stock 
and  securities  in  a  capacity  other  than  of  a  bona  fide  owner;  and  this 
affiant  has  no  reason  to  believe  that  any  other  person,  association,  or 
corporation  has  any  interest  direct  or  indirect  in  the  said  stock,  bonds, 
or  other  securities  than  as  so  stated  by  him. 

5.  That  the  average  number  of  copies  of  each  issue  of  this  publication 
sold  or  distributed,  through  the  mails  or  otherwise,  to  paid  subscribers 
during  the  six  months  preceding  the  date  shown  above  is  (This  informa- 
tion is  required  from  daily  publications  only) : 

(Signature  of  editor,  publisher,  business  manager,  or  owner) :  Nathan 
Winslow. 

Sworn  to  and  subscribed  before  me  this  21st  day  of  Sep- 
tember, 1921. 
(Seal) 

Eleanor  H.  Muhly. 
(My  commission  expires  May  1,  1922.) 


UNIVERSITY  OF  MARYLAND 

BULLETIN 

OP   THE 

SCHOOL  OF  MEDICINE 

Vol.  VI.  JANTJAEY.  1922.  No.  3 


NASAL  OBSTEUCTION  AS  A  FACTOE  IN  PEO'DUCING 
ASTHENOPIO  SYMPTOMS— WITH  EEPOET 

OF  CASES. 

Edw.  a.  Looper,  M.  D.,  Oph.  D. 
Professor  of  Diseases  of  the  Nose  and  Throat,  University  of 

Maryland. 

My  object  in  reporting  the  following  cases  is  to  direct  more 
attention  to  a  routine  exaniination  of  the  nose  in  cases  with  low 
grade  refraction  errors  which  present  all  the  symptomsi  of  asthe- 
nopia, sncli  as  dull  frontal  headache,  pain  in  the  eyes  and  orbit, 
sensitivenesis  and  a  heavy  feeling  at  the  bridge  of  the  nose,  chronic 
catarrhal  conjunctivitis  and  inability  to  use  the  eyes  for  any  great 
length  of  time. 

In  cases  preisenting  such  symptoms  of  asthenopia,  the  oculist 
naturally  thinks  that  all  the  trouble  can  be  relieved  by  the  proper 
correction  with  glasses.  Often,  to  his  disappointment,  the  patient 
returns  complaining  as  much  or  more  than  ever,  and  it  is  not  until 
later  after  a  high  deflection  of  the  septum  has  been  corrected,  a 
spur  removed  or  possibly  a  hyperplastic  middle  turbinate  has  been 
resected  that  the  condition  isi  entirely  relieved,  and  it  is  imnecesr 
sary  to  use  glasses. 

This  particular  type  of  case  generally  goes  to  the  oculist  instead 
of  to  a  rhinologist,  because  in  the  first  place,  people  have  been 
pretty  well  taught  that  eye  strain  is  the  cause  of  nearly  all  head- 
aches. Secondly  because  there  may  be  no  nasal  discharge,  which 
as  we  know  now  is  not  the  important  symptom  in  indicating  nasal 
pathology  it  once  was,  for  as  a  matter  of  fact  in  this  particular 
type  it  is  indeed  unusual  to  have  nasal  discharge. 

Another  symptom,  difficulty  in  nasal  breathing,  which  is  gen- 
erally known  to  the  lay  mind  as  a  distinctive  anomaly,  is  not  al- 
ways manifest.  A  patient  may  go  for  years  Avith  one  side  of  his 
nose  practically  occluded  without  noticeable  inconvenience,  as  long 
as  he  has  plenty  of  breathing  space  on  the  other  side. 


34 

We  are  indebted  to  Sluder  for  the  ]>ioiieer  work  in  this  group  of 
oases.  He  has  described^  them  as  vacuum  frontal  headaches  with 
eve  symptoms  only.  His  observations  have  been  that  few  of  the 
cases  present  definite  nasal  symptoms.  No  nasal  discharge,  no 
clouding  of  the  sinuses,  but  constant  dull  frontal  headache  with 
tenderness  under  the  floor  of  the  frontal  sinus  at  the  upper  inner 
angle  of  the  orbit  near  the  attachment  of  the  pulley  of  the  superior 
(il)lique  muscle,  the  so-called  Ewing  sign.^  This  sign  is  really 
the  only  characteristic  symptom  of  this  condition. 

It  was  first  demonstrated  by  Ewing  in  1900,  and  is  produced  by 
exerting  a  point  of  pressure  where  the  pulley  of  the  superior  oblique 
muscle  is  attached  to  the  orbit.  In  his  book  on  "Headaches  and 
Eye  Disorders  of  l^asal  Origin,"  Sluder^  has  given  an  excellent 
account  of  the  causes  producing  this  condition.  A  brief  summary 
of  his  observations  show  the  underlying  factors  to  be  the  result  of 
some  mechanical  nasal  obstruction  which  interferes  with  the  drain- 
age and  ventilation  from  the  sinuses,  particulariy  the  frontal.  A 
\'acuum  is  created  with  consequent  congestion  of  the  lining  mucous 
membrane  with  secondary  involvement  of  the  thin  bony  wall,  so  that 
any  pressaire  exerted  at  this  point  produces  tenderness.  The  pulley 
of  the  superior  oblique  is  attached  to  tlie  thinnest  part  of  this  bony 
wall  so  that  any  act  of  accommodation  or  movement  of  the  eye 
produces  a  tugging  at  this  point  sufficient  to  produce  a  constant 
dull  frontal  headache. 

The  nasal  obstruction  may  be  an  enlarged  middle  turbinate 
which  completely  blocks  the  inlet  to  the  frontal  sinus.  A  very 
common  cause  is  a  high  deviation  of  the  septum  which  in  the  same 
way  prevents  the  proper  drainage  and  ventilation  of  the  frontal 
sinus.  Other  causes  tO'  be  enumerated  are :  Lack  of  development 
of  the  vault  so  that  the  middle  turbinate!  may  be  pressed  against 
the  outer  wall.  Swelling  of  the  soft  tissues  causing  an  edema  of 
the  vault  with  later  development  of  polyps.  Empyemas  and  cory- 
zas  which  have  become  cured  but  have  left  enough  hypertrophy  in 
the  vault  of  the  middle  meatus  to  close'  off  the  ventilation  of  the 
frontal  sinus. 

REroRT  OF  Cases. 

No.  1 — Mrs.  G.  L.,  aged  43.  consulted  me  in  October,  1919,  for 
relief  of  constant  frontal  headache.  She  had  been  refracted  a  num- 
ber of  times  and  proper  correcting  lenses  given  without  improve- 
ment of  her  condition.  Glasses  felt  veiy  heavy  over  bridge  of  nose 
and  altogether  were  very  irritating.  Very  neiwous.  Appetite  poor. 
Th'd  not  sleep  well.  ISTose  congested  on  left  side  most  of  the  time 
with  obstruction  to  breathing.  Persistent  frontal  headache.-  with  a 
dull  lieavv  feelino;  liotween  eyes.     Tenderness  under  floor  of  left 


35 

frontal  sinus.  Transillumination  and  X-ray  showed  no  clouding 
of  sinuses.  Septum  had  a  high  deviation  to  the  left  side  pressing 
on  middle  turbinate. 

Treatment — On  October  20,  1919,  a  submucous  resection  was 
performed  and  deviation  con-ected.  E'o  complications.  Patient 
had  an  uneventful  recovery  and  in  a  week  all  disagreeable  symp^- 
toms  had  disappeaxed. 

Since  operation  she  has  had  no  headache,  no  nasal  symptoms  and 
her  nervousness  has  disappeared.  She  has  gained  ten  pounds  in 
weight  and  feels  fine. 

l^o.  2 — Mrs.  C.  H.,  aged  36,  was  refen-ed  to  me  for  treatment 
of  severe  frontal  headaches.  She  complained  of  pain  in  her  eyes-. 
Headaches,  which  became  vei-y  severe  at  times.  Difficulty  in  using 
her  eyes  any  great  length  of  time.  No  relief  of  symptoms  by 
glasses. 

Examination  of  nose  showed  great  hyp<>rtrophy  of  both  middle 
turbinates.  X-ray  and  transillumination  of  sinuses  were  negative. 
No  nasal  discharge.  Tenderness  at  upper  inner  angle  of  orbit. 
Tinder  local  anesthesia  the  anterior  third  of  middle  turbinates  were 
resected  which  has  given  patient  permanent  relief. 

No.  3^ — Mrs,  R.  0.,  aged  34,  complained  of  constant  frontal  head- 
ache, pain  in  eyes,  nervousness  and  irritability,  frequent  attacks  of 
vertigo,  a  congested  and  heavy  feeling  in  the  nose.  Her  refra,ction 
error  had  been  corrected  several  months  previously,  but  symptoms 
of  asthenopia  persisted.  She  gave  no  history  of  nasal  discharge, 
sinuses  were  clear  by  transillumination  and  X-ray  examination. 
No  postnasal  discharge.  Ewing's  sign  present.  The  septum  showed 
a  very  high  deviation  to  the  left  which  obstructed  the  naso-fronti)l 
duct. 

After  correction  of  the  deflected  septum  by  a  submucous  resec- 
tion her  symptoms  cleared  up  and  she  has  had  no  subsequent 
trouble. 

No.  4 — Mrs.  E.  H.  gave  a  history  of  constant  frontal  headache 
and  pain  between  her  eyes.  She  had  been  refracted,  but  glasses 
did  not  relieve  her  symptoms.  Examination  of  her  nose  showed  a 
rather  high  posterior  deviation  to  the  right.  There  wasi  no  nasal 
discharge.  Sinuses  were  negative  by  transillumination  and  X-ray 
examination.  In  fact,  nasal  and  physical  examination  were  nega- 
tive except  for  septal  deviation. 

The  deviation  was  corrected  by  a  submucous  resection.  Since 
that  time  all  symptoms  have  cleared  up  and  there  has  been  no  re- 
cun-ence. 

No.  5 — Mrs.  H.  K.,  aged  35,  complained  of  pain  in  her  eyes 
after  reading.  Lids  were  injected  a  great  deal  of  the  time.  There 
was  some  difficulty  in  breathing.    No  nasal  discharge.     Some  pain 


36 

across  the  bridge  of  the  nose.  Patieiit  had  been  refracted  and  re- 
sults checked  up  a  number  of  times,  but  asthenopic  symptoms  were 
not  relieved,  after  which  she  was  referred  to  me  for  investigation 
of  the  nose  as  the  probable  cause  of  the  a,bove  symptoms. 

Examination  showed  a  fairly  straight  septum,  but  the  middle 
turbinates  were  very  large  and  pressing  against  the  septum.  X-ray 
examination  and  transillumination  showed  all  sinuses  to  ]ye  clear. 
It  was  apparent  that  most  of  these  symptoms  werci  the  result  of 
hypertrophied  turbinates,  so  local  treatment  was  instituted  to 
shrink  the  congested  turbinates.  After  a  few  treatments  the  symp- 
toms cleared  up  and  the  patient  has  had  no  further  trouble. 

Summary. 

1.  Many  obscure  cases  presenting  typical  asthenopic  symptoms 
which  have  not  been  relieved  by  refraction  can  be  cured  by  the 
proper  nasal  treatment. 

2.  Most  of  these  cases  come  primarily  to  the  oculist,  for  their 
symptoms  are  suggestive  only  of  eye  involvement. 

3.  None  of  the  cases  complained  of  nasal  discharge  or  annoy- 
ing nasal  symptoms.    No  clouding  of  sinuses. 

4.  Every  thorough  eye  examination  should  be  accompanied  by 
a  nasal  examination. 

REFERENCES. 

iSluder — Headaches  and  Eye  Disorders  of  Nasal  Origin— C.  V.  Mosby 
&  Co. 

2Ewing,  A.  E. — A  Point  in  the  Diagnosis  of  Frontal  Headache^St.  Louis 
Courier  Medical  Journal  1S09,  P.  370. 

■iEwing,  A.  E.,  and  Sluder,  Greenfield — Frontal  Headaches  Apparently 
Ocular,  but  Really  of  Nasal  Origin.  Their  Recognition  and  Treatment. 
Trans.  American  Ophth'almological  Society,  Vol.  9,  PP.  60-70. 

4Lynch,  R.  C. — Vacuum  Disease  of  the  Maxillary  Sinus — Annals  of 
Otology  and  Rhinology.  1914. 

PEURITi^. 
Haeey  M.  Eobinson,  M.  D. 

Itching  is  probably  the  most  frequent  subjective  symptom  that 
is  encountered  as  a  human  complaint,  and,  while  most  often  met. 
with  in  the  course  of  a  physician's  work,  it  is  not  infrequent  in 
those  apparently  health}^  It  may  be  mild  and  evanescent,  or  it 
may  be  severe  and  resistant  to  all  our  known  empiric  remedies.  In 
former  years  when  the  more  annoying  and  persistant  phases  of 
general  itching  were  met  with,  and  the  etiological  factors  were 
obscure,  the  name  pruritis  (from  the  Latin,  prurire,  meaning  to 
itch)  was  given  and  these  conditions  were  termed  primary  or  iodio- 
pathic  neuroses.  Under  this  heading  were  placed  those  continued 
or  intermittent  attacks  of  severe  itching,  where  no  lesion  was  seen 


37 

and  no  cause  was  detected.  But  in  these  later  years  it  has  been 
shown  that  many  of  the  cases  of  iodiopathic  prnritis  were  merely 
unknown  or  uncommon  symptoms  of  various  diseases  such  as  latent 
syphilis/  tabes,^  diabetes,  drug  ingestions,  food  anaphylaxis,  con- 
stipation, and  external  factors  such  as  heat  and  clothes. 

So,  that  now  pruritis  is  more  frequently  considered  as  a  symp- 
tom even  when  the  cause  is  not  readily  discernible ;  and  the  search 
for  the  disease  which  it  accompaniesi  is  receiving  the  necessary  at- 
tention. 

It  is  undoubtedly  a  neurosis,  but  only  in  so  far  as  some  definite 
cause  or  toxin  is  disturbing  the  end  nerves;  and  it  is  that  cause 
which  it  is  the  problem  of  the  physician  to  ferret  out  and  get  rid 
of.  It  may  be  a  metabolic  factor,  it  may  be  some  external  influ- 
ence or  it  may  be  that  obscure  condition,  excess  or  insufficiency  of 
endocrine  secretion."  But  whatever  it  is,  we  are  surely  nearing 
the  stage  where  local  applications  such  as  phenol,  liquor  carbonis 
detergens  or  X-ray,  given  as  a  venture,  will  be  less  frequent  and 
the  definitely  indicated  therapeutic  agent  will  be  prescribed.  It 
will  not  be  necessary  to  do  a  Ball  operation^  or  an  alcoholic  injec- 
tion^ in  pruritis  ani,  for  it  may  be  true  that  the  cause  is  streptococ- 
cus faecalis*^  or  Bac.  coli  communis  infection,'''  and  a  vaccine  will 
eliminate  the  cause  and  the  itching.  It  may  even  be  possible  that 
senile  pruritis  is  an  endocrine  condition  which  we  should  try  to 
.demonstrate.  But  it  isi  undoubted  that  many  if  not  most  of  the 
cases  of  itching  are  toxemic  or  anaphylactic  in  origin  and  the 
proper  diet  must  be  prescribed. 

It  should  not  be  sufficient  for  a  physician  to  give  haphazard 
dietary  directions  to  all  patients  alike,  whether  with  acne,  eczema, 
urtricaria,  rosacea  or  itching, — and  to  say  "Don't  eat  candy,  cake, 
ice  cream,  meats  or  fried  thing,"  for  it  is  just  possible  that  those 
may  be  the  articles  which  are  not  anaphylactic,  and  we  make  no 
headway.  Because  as  Highman^  quotes,  "what  is  one  man's  meat 
is  another  man's  poison,"  and  shows  that  carrots  alone  can  cause 
urticaria,  in  some  patients. 

Therefore,  there  should  be  a  definite  procedure  in  all  dei-matoses 
of  unknown  origin.  Undoubtedly  the  right  way  would  be  to  make 
each  patient  undergo  a  thorough  metabolic  and  excretory  examina- 
tion such  as  Dr.  McElfresh  of  the  University  Hospital  has  done  so 
ably  for  so  many  years.  Then,  the  patient's  food  and  fluids  should 
be  supervised  as  taken  in  and  a  chemical,  microscopical  and  quan- 
titative analyses  should  be  done  on  all  excreta  (feces,  urine,  sweat). 
There  should  be  an  examination  of  the  gastric  contents  and  the  urea 
and  sugar  contents  of  the  blood  obtained.  This  would  be  ideal. 
But  as  it  is  practically  not  feasible  for  want  of  ward  facilities,  we 
must  be  satisfied  with  the  next  best  methods.  With  Highman,^  we 
have  not  had  vcrv  reliable  results  with  the  sensitization  test  with 


38 

dried  foods,  but  in  absence  of  better  tests,  they  should  l>e  employed. 
Another  test  would  bo  to  examine  the  feces^  chemically  and  mi- 
scropically  for  metabolic  insufficiency  with  some  assurance  of  suc- 
cess. And  in  addition  to  this  latter  examination  I  have  insisted  on 
the  paitient  keeping  what  I  call  a  food  diary.  While  this  idea  is 
imperfect,  it  is  yet  somewhat  bettei*  than  the  routine  taboo  which 
all  patients  receive.  If,  as  has  been  shown,  that  certain  patients 
were  kept  free  from  itching  and  urticaria  by  eliminating  from  their 
diet  such  simple  articles  as  carrots,  in  one  case,  buckwheat  in  an- 
other, it  is  wrong  to  tell  all  patients  to  refrain  from  the  same  arti- 
cles of  diet.  Although  I  have  found  that  coffee  was  alone  the  dis- 
turbing element  in  8  oases  of  prnritis  and  a  cure  resulted  by  for- 
bidding it,  yet.  we  have  seen  many  patients  who  never  have  had  ill 
effects  from  coffee-  although  partaking  of  it  for  many  years. 

The  examination  of  the  feces  will  show  among  other  things,  what 
is  not  being  digested  and  the  food  diary  should  show  whether  the 
patient  eats  regularly  and  what  articles  most  frequently  and  in 
excess. 

I  append  here  a  sample  page  from  diary  of  Mis®  W.  C,  condi- 
tion, general  itching  with  two  small  patches  of  dennatitis : 

I  FOOD  DIAEY. 

I  r  ~  SUNDAY. 

Breakfast,  10.30.  Dmner,  5  P.  M. 

Grape  Fruit.  Toast  with  Butter.  Milk. 

Fried  Scrapple  Pork  and  Sauerkraut. 

Milk.  Mashea  Potatoes.  Corn. 

Pineapple. 
Apples  and  Peanut  Butter  all  Afternoon. 

MONDAY. 

Breakfast.                            ■  Dinner. 

Scrapple.                 Toast  with  Butter.  Broiled  Chicken. 

Lunch.  Olives. 

Bottle  of  Milk.  Wafrles  with  Butter. 

Tongue  Sandwich  with  Butter.  Boiled  Potatoes. 

Candy  all  Afternoon.               '  Jello. 
TT'ESDAY. 

Breakfast.  3  /'.  M. 

Grape  Fruit.                            Scrapple.  Ham  Sandwich. 

Toast  with  Butter.  Half  Oran.tre. 
Milk.                        Cocoa, 

o.vsterettes  all  Afternoon.  I>i»iicr. 

Lunch.  P.oiled  Ilani. 
Boiled  Beef.              Mashed  Potatoes.  Boiled  Potatoes. 
Bread  and  Butter.         Milk.  Boiled  Cahbage. 
Strawberry  Ice  Cream.  Bread  I'udding. 
Stopping  candy  and  insisting  that    nothing  lie  eaten  lietween  meals  re- 
lieved the  itching  very  nnicli.     Sciapiilc  and  pork  meat  also  interdicted. 


39 

Report  of  Cases. 

In  a  collection  of  26  cases  the  following  were  found  apparently 
to  be  the  causes : 

In  8  cases  (already  mentioned),  coffee  was  the  irritant.  One 
woman  with  an  itching  of  G  weeks  duration  had  been  using  cala- 
mine lotion  with  no  results.  Food  Diary  showed  she  drank  at  least 
10  cups  of  coffee  a  day.  Cured  on  stopping  coffee.  Another  fre- 
quently took  8  to  10  cups  at  one  meal.  When  told  the  probable 
cause,  she  stopped  coffee ;  result  immediate  relief. 

One  case,  due  to  grape  fruit  eaten  three  times  a  day. 

One  case,  due  to  tomatoes. 

Two  cases,  the^  itching  occured  when  the  skin  dried  after  profuse 
sweating.     Frequent  bathing  advised,  with  beneficial  results. 

One  case,  patient  itched  markedly  only  when  excited. 

Two  cases,  latent  syphilis,  Wassermann  positive,  no  apparent 
lesions. 

In  9  cases,  where  I  could  not  find  thei  cause,  and  all  others  of 
metabolic  origin,  I  gave  six  injections  of  Adrenalin  Sol.  1-1000,  10 
minims  every  other  day,  with  improvement  in  all.  The  slight 
pallor' and  nervous  tremor  following  the  injection  was  not  severe 
enough  to  consider  contraindicative. 

In  conclusion,  while  I  have  found,  as  have  other  men,''^  that 
adrenalin  injected  subcutaneously  in  from  5  to  10  minim  doses 
often  helps  very  much  in  these  food  toxemias,  it  should  not  degen- 
erate into  an  empiric  therapeutic  agent,  given  in  all  cases  of  itch- 
ing, witliout  search  for  the  cause,  which  may  even  be  more  appar- 
ent than  the  alx>ve  mentioned. 

KEFEltEXCES. 
illolliuulei'.  I>. :  Archives  Derm.  \:  Syphilis,  Vol.   1.  Xo.   1,  u.  'ui. 
-Vignolo-Lutati,  C;  Gazz.  deg.  Osped.  e  dell  Clin.,  Milan;   quoted  Jl.  A. 
M.  A.,  Vol.  69,  No.  6. 

•Kechet,  P.:  Archiv.  Derm.  &  Syph.,  Vol.  4,  No.  5. 
'DaCosta.  J.  C. :  Modern  Surgery,  1910.  p.  1172. 
-Stone,  H.  P..;  lUilletiu  Johns  Hopkins  IIosp.,  Vol.  27,  No.  306. 
'Murray.  D.  II.;  J.  A.  M.  A.,  Vol.  07,  page  1913. 
"Winfied,  J.  MacF. ;  Archiv.  Derm.  &  Syph.,  Vol.  4,  No.  5. 
;        sHighman,  W.  .1..  &  Michael,  .7.  C. ;  Archiv.  Derm.  &  Syph.,  Vol.  2,  No.  5. 
fWhite.  C.  .7. :  .lour.  Cutan.  Diseases.  Vol.  .34.  No.  2.  p.  .57. 

MESENTERIC  THROMBOSIS 
J.  :\f.  Hr.xDLEY,  Sr.,  M.D.,  Nathan  Winslow,  M.D.,  axd 

J.  M.  Hundley,  Jr.,  M.D. 
Mesenteric  thrombosis  is  sufficieutl}^  unusual  to  warrant  the  re- 
porting of  all  such  cases.     We,  therefore,  desire  to  place  on  record 
two  cases  which  came  under  our  obser\'ation.     Both  were  seen  at 


40 

the  University  Hospital.  In  neitJier  was  the  actual  condition  sus- 
pected prior  to  operation.  One  was  taken  for  a  ruptured  duodenal 
or  gastric  ulcer,  tiie  other  for  a  volvulus.  The  patients  were  men, 
aged  36  and  38  years  respectively;  both  died.  Stoppage  of  the 
mesenteric  vessels  occurs  in  two  forms,  acute  and  chronic.  The 
artery  alone,  the  vein  alone,  or  both  simultaneously  may  be  blocked, 
and  the  frequency  is  in  the  order  named.  The  superior  mesenteric 
vessels  are  more  frequently  aifected  than  the  inferior.  Notwith- 
standing the  superior  mesenteric  is  an  end  artery,  it  has  been 
found,  at  autopsy,  completely  obliterated,  without  apparent  change 
to  the  portion  of  the  alimentary  canal  it  supplies.  Virchow  re- 
ported two  such  cases.  The  case  of  Chiene  (Jl.  Anat.  and  Phys.. 
1868,  part  III,  p.  65)  is  still  more  remarkable.  The  obsen^ation 
was  made  in  a  female  who  died  at  the  age  of  65,  of  paralysis. 
Amongst  other  things  the  pathology  showed  an  aneurism  of  the 
abdominal  aorta  from  the  lower  pole  of  which  the  inferior  mesen- 
teric artery  issmed  and  a  studding  of  the  aortic  walls  with  athero- 
matous patches.  The  celiac  axis  with  the  exception  of  its  first  half 
inch  had  been  converted  intO'  an  impervious  cord  and  the  mesen- 
teric arteries  were  in  a  similar  condition,  yeit  with  such  widespread 
circulatory  disturbances  there  w^ere  no  changes  in  the  stomach  or 
intestines,  proving  that  a,  slow  closure  by  affording  an  opportunity 
for  the  formation  of  an  adequate  collateral  circulation  is  not  al- 
ways prejudicial  to  life.  On  the  other  hand  when  the  stoppage  is 
sudden,  death  inevitably  results  from  gangrene  and  peritonitis,  un- 
less prompt  operative  measures  are  instituted,  and  even  then  ac- 
cording to  Jackson,  Porter  and  Quinby  (Jl.  Amer.  Med.  Assoc, 
1904,  Vol.  I,  p.  1469,  and  1904,  Vol.  II,  pp.  29,  110,  183)  the 
mortality  is  92  per  cent.  Schley  attributes  the  high  death  rate  to 
indecision  in  diagnosis  and  tardy  operation.  This  is  undoubtedly 
true  in  those  cases  where  the  damage  is  limited  to  a  coil  or  two  of 
intestine,  but  does  not  apply  when  almost  the  entire  small  and  a 
goodly  portion  of  the  great  gut  are  gangrenous. 

Case  I. — W.  B.,  white,  male,  aged  36,  electrician,  was  admitted 
to  the  University  Hospital,  July  29,  1920,  for  a  ruptured  duodenal 
or  gastric  ulcer.  He  had  been  suffering  with  indigestion  and 
constipation  for  several  months.  During  the  last  month  of  his 
illness  he  experienced  considerable  i^ain  on  defecation.  Fourteen 
hours  before  he  was  brought  to  the  hospital  he  was  seized  with  an 
acute  abdominal  pain.  On  admission  examination  showed  a  board- 
like  belly,  the  pulse  was  thin  and  fast  and  the  expression  was  very 
anxious.  Ho  was  evidently  a  very  ill  man.  The  symptoms  were  so 
puzzling  that  a  positive  diagnosis  was  not  ventured,  bnt  it  was 
thought  he  was  probably  suffering  with  a  ruptured  gastric;  or  duo- 
denal ulcer.     Operatiou  was  suggested  and  accepted.     So  he  was 


41 

made  ready  and  taken  soon  thereafter  tO'  the  operating  room,  where 
under  gas  anesthesia  the:  abdomen  was  opened  by  a  long  right 
rectus  incision.  Upon  retraction  of  the  abdominal  walls,  a  coil  of 
moderately  distended,  bluish-black  intestine  popped  into  the  wound. 
This  proved  on  closer  investigation  to  be  large  bowel.  The  dis- 
coloration began  in  the  cecum,  thence  extended  up  the  ascending 
colon,  across  the  transverse,  down  the  descending,  around  the  sig- 
moid and  on  to  the  rectum  where  it  was  brought  to  a  sudden  check 
by  an  annular  carcinoma  which  had  failed  of  detection  by  a  dig- 
ital exploration  per  annum  because  of  its  height.  Thei  stomach  and 
intestines  were  apparently  unchanged.  The  patient  went  into  col- 
lapse immediately  the  operation  was  begun  and  died  on  the  table. 
Fearing  an  autopsy  would  be  denied,  a,  hasty  search  was  made  for 
the  cause  of  the  gangrene,  as  it  wasi  not  thought  the  carinomatous 
rectum  could  possibly  produce  such  widcispread  destruction.  This 
investigation  led  to  the  detection  of  extensive  thrombosis  of  the 
lower  mesenteric  veins.  Whether  a  bacterial  invasion  occurred 
through  the  sitei  of  maligTiancy  would  be  merely  a  guess.  Unfortu- 
nately a  culture  was  neglected. 

Case  II. — R.  F.,  white,  male,  aged  38,  was  admitted  to  the 
University  Hospital,  June  22,  1921,  for  paroxysmal  pain  in  the 
upper  abdomen.  FWr  days  before  he  was  suddenly  seized  with 
severe,  colicky  pains  which  were  distributed  throughout  the  abdo- 
men. Under  the  impression  that  a  cleansing  of  the  intestinal  canal 
might  prove  beneficial  he  took  a  laxative  which  was  effectual.  The 
day  following  developed  nothing  new,  but  the  pain  was  by  this 
time  more  severe  and  had  definitely  localized  in  the  lower  left  ab- 
dominal quadrant.  He  had  on  that  day  several  copious  movements. 
The  next  day,  the  patient  felt  much  worse.  The  pain  was  as  severe 
as  ever,  and  he  had  begun  to  vomit  a  dark  brown  fluid.  On  the 
morning  of  admission  a  large  quantity  of  bloody  water  was  passed 
per  rectum.  The  vomiting  still  persisted  and  there  was  no  abate- 
ment of  the  pain.  The  abdomen  was  moderately  distended  and 
sore  throughout.  The  muscles  at  the  bottom  of  the  abdomen  on  the 
left  side  felt  slightly  more  teuse  to  touch  than  elsewhere.  The 
temperature  was  99%  F.,  pulse  80,  respirations  20,  the  white  cells, 
20,200.  A  volvulus  was  suspected  and  operation  advised.  Under 
ether,  the  abdomen  was  opened  by  a  long  low  left  rectus  incision. 
"When  the  peritoneum  was  incised,  coils  of  bluish-black  gut  pre- 
sented in  the  wound.  A  rapid  inspection  showed  the  lower  two- 
fifths  of  the  jejunum  and  all  of  the  ileum  except  the  terminal  two 
or  three  inches  black  but  the  peritoneal  coat  still  glistening.  The 
cecum  and  ascending  colon  were  mottled  and  deeply  injected  to  the 
level  of  the  hepatic  flexure.  The  entire  intestinal  canal  was  mod- 
erately distended.  ISTo  masses  were  palpable.   ISFo  adhesions,  bands, 


k 


42 

collapsed  bowel,  or  free  fluid  was  found,  in  fact  no  gross  lesion  suf- 
ficient to  account  for  the  widespread  damage.  At  this  time  it  was 
supposed  that  during  the  manipulation  of  the  intesitines  a  vo^oilus 
had  been  unwittingly  reduced,  so  the  abdomen  was  closed.  The 
patient  withstood  the  operation  well  and  developed  no  alarming 
S'jTnptomSi  until  after  midnight  when  the  pulse  liecame  weak  and 
the  mind  began  to  wander.  Shortly  thereafter  he  commenced  to 
vomit  a  coffee  ground  material,  went  into  collapse,  and  died  at 
6.40  A.  M.,  Jime  23,  1921. 

Autopsy,  6-23-1921.  Permission  was  gTauted  for  an  inspection 
of  the  abdominal  viscera  only.  The  parietal  peritoneum  was  ever\-- 
where  dark  purplish  in  appearance.  The  intestines  were  distended. 
The  small  was  black  and  emitted  a  gangi-enous  odor.  Its  peritoneal 
coat  was  lustreless  and  tore  readily.  The  mesenteiy  was  thick, 
studded  with  extravasated  blood  and  torn  easily.  The  large  intes- 
tine was  dark  and  deeply  congested.  The  abdominal  aorta  and 
brancheis  were  dissected  out.  In  the  lumen  of  the  superior  mesen- 
teric artery  at  a  point  about  where  it  emerged  from  beneath  the 
pancreas  was  a  clot  about  one  inch  long.  The  intima  of  the  aorta 
was  thickened  and  showed  vaHousi  stages  of  arterio^sclerosis.  In 
the  iliacs  were  calcareous  deposits  which  encroached  on  the  lumen 
but  did  not  occlude  it. 

Whilst  the  mortality  in  this  condition  is  appalling,  especially  in 
the  acute  form,  stMl  occasionally  a  case  finds  its  way  into  print  in 
which  operation  has  given  relief.  At  the  December  13,  1911,  meet- 
ing of  the  ISTew  York  Surgical  Society,  Green  (Annals  of  Surg., 
1912,  LV,  458)  presented  a  woman,  43  years  old  who  had  been 
admitted  to  St.  Luke's  Hospital,  June  19,  1911.  Her  illness  be- 
gan one  week  before  admission  when  she  ate  some  food  which  gave 
her  a  diarrhoea  and  cramps  foi-  two  dajs,  and  on  one  occasion, 
three  days  before  admission  she  passed  a  tarry  stool.  At  3  A.  M., 
on  the  day  of  her  admission  she  was  awakened  with  a  severe  ab- 
dominal pain.  It  gradually  increased  in  severity  and  remained 
localized  in  the  mid  abdomen.  She  complained  of  much  pain  about 
the  umbilicus.  She  was  given  some  medication  which  was  followed 
by  nausea  and  vomiting.  All  the  signs  pointed  to  an  intestinal 
obstruction,  so  an  operation  was  decided  upon.  This  was  per- 
foi*med  16  hours  after  the  onset  of  the  attack.  TTpon  opening  the 
peritoneum  a  liter  of  reddish  tinted  fluid  escaped.  A  search  for 
the  trouble  uncovered  a  coil  of  reddish-black  intestine  ai'ising  in 
the  left  iliac  fossa  and  extending  across  the  abdominal  cavity  to- 
ward the  ileocecal  region.  The  discoloration  was  not  unifomi  be- 
ing lighter  in  some  places  than  in  other.  The  mesentery  was  red 
and  edematous  along  its  intestinal  attachment.  Despite  the  exci- 
sion of  over  5I/2  feet  of  intestine  and  an  end  to  end  anastomosis  by 


43 

button,  the  patient  made  an  uneventful  recovery.  The  pathological 
examination  showed  thrombosis  of  the  veins  in  the  mesentery.  An- 
other to  operate  successfully  was  Schley  (Martin,  Annals  of  Surg.., 
1911,  LIV,  253).  The  patient,  a  man,  was  suddenly  taken  sick 
24  hours  before  admission  to  St.  Luke's  Hospital,  on  December  23, 
1910.  Several  hours  after  a  meal  there  was  a  sharp  pain  across 
the  upper  abdomen.  The  pain  was  continuous  from  the  onset.  He 
vomited  once  or  twice,  but  the  vomitus  contained  no  blood.  The 
bowels  had  moved  naturally  the  morning  before  the  attack,  but  not 
afterwai-ds,  nor  had  he  passed  any  flatus.  His  temperature  on  ad- 
mission was  100  3/5  F.,  pulse  94,  respirations  24,  leucocyte  count 
20,000,  with  a  polynuclear  percentage  of  89.  The  symptoms  were 
so  puzzling  that  no  definite  diagTiosis  was  ventured.  On  opening 
the  abdomen  by  a  low  midline  incision,  a  loop  of  black-red  gut 
presented.  It  showed  a  sharps  line  of  demarkation  at  either  end 
from  the  healthy  intestine.  The  mesentery  for  from  2  to  6  inches 
from  the  attachment  to  the  bowel  wasi  black  and  mottled.  Bleed- 
ing from  the  arteries  was  demonstrated,  but  the  veins  were  throm- 
bosed. The  diseased  gut  was  excised  with  four  inches  of  healthy 
bowel  on  either  side  of  the  involved  area,  and  the  mesentery  well 
beyond  the  limits  of  discoloration.  Thei  continuity  of  the  intestinal 
canal  was  re-established  with  a  Murphy  button.  The  patient  was 
discharged  February  14,  1911,  in  good  condition.  Elliott  (Annals 
of  Surg.,  1895,  XXI,  9)  repoirts  a  case  in  which  he  resected  48 
inches  successfully,  and  Lindner  (Koelbing  in  Bruns  Beitraege, 
1902,  XXXIII,)  50  cm.  The  attack  is  ushered  in  with  sudden, 
excruciating  and  paroxysmal  pain,  nausea  and  vomiting,  followed 
quickly  by  absolute  constipation  or  in  rare  instances  by  frequent 
bloody  alvine  evacuations.  At  first  the  temperature  and  pulse  rate 
are  but  slightly  increased,  if  at  all.  With  the  advent  of  peritoneal 
infection  collapse  becomes  a  prominent  feature.  The  pulse  is  in- 
creased in  frequency  and  the  temperature  gradually  ascends.  Whilst 
the  diagTiosis  is  not  generally  made  until  aftei-  operation,  the 
patient  will  suffer  none  by  this  oversight,  if  his  physician  realizes 
he  is  dealing  with  an  "acute  abdomen"  and  resorts  to  early  opera- 
tion. LTn certainty  should  cease  with  the  opening  of  the  abdomen, 
unfortunately  such  is  not  always  the  case.  Loop  (Trans,  of  the 
Sect,  on  Gen.  and  Abd.  Surg,  of  the  A.  M.  A.,  1921,  p.  104) 
relates  in  the  histories  of  the  first  two  cases  operated  on  by  him,  he 
did  not  appreciate  the  cause.  This  experience  is  common  to  many 
others  and  is  not  to  he  wondered  at  because  the  pathology  is  so 
bizarre,  so  weird  and  so  at  variance  with  anything  ever  seen  be- 
fore. The  presence  of  deeply  injected,  glistening,  plum  or  ma- 
hogany tinted,  moderately  distended  coils  of  bowel,  with  no  ac- 
countable cause,  especially  if  the  mesenteric  arteries  are  pulsation- 


44 

less,  means  either  a  mesenteric  thrombosis  or  embolism.  Mnrphy 
(The  Clinics  of,  1914,  III,  627)  cites  as  a  typical  example  of  the 
latter,  the  following  case:  The  patient  had  an  acute  recurrence  of 
a  mitral  endocarditis,  which  kept  him  in  bed  for  seA^en  weeks. 
When  the  acute  symptoms  had  subsided,  he  left  the  hospital.  He 
was  practically  well,  with  a  pulse  ranging  from  80  to  90,  a  normal 
temperature,  a  normal  whitei  cell  count  and  a  moderate  secondary 
anemia.  He  had  been  hoime  for  four  or  five  days,  when  one  night 
he  suddenly  called  his  nurse  and  said  to  her:  ''Something  has  hap- 
pened ;  I  have  just  had  a  severe  pain  in  my  abdomen."  The  nurse 
took  his  pulse  and  found  it  running  along  at  the  rate  of  140  per 
minute.  His  doctor,  when  he  came  in  the  morning,  examined  the 
patient  and  noticed  that  the  abdomen  was  sensitive  on  the  right 
side.  The  patient  then  had  pain,  nausea  and  vomiting,  but  no 
elevation  of  temperature.  ISTevertheless  the  doctor  made  a  diag- 
nosis of  appendicitis.  'Now,  appendicitis,  never  begins  with  a  pulse 
rate  of  140  in  the  first  five,  six  or  seven  minutes  of  the  onset.  In 
perforative!  peritonitis,  even,  it  takes  time  for  the  symptoms  to  de- 
velop, particularly  the  rapid  pulse.  The  doctor  called  another  phy- 
sician in  consultation,  and  it  was  decided  to  operate  for  appen- 
dicitis. He  telephoned  Murphy  who  in  the  conversation  over  the 
telephone  said :  ''You  remember  that  man  had  a  liver  embolus  dur- 
ing his  recent  attack  of  endociarditis,  I  think  you  ought  to  consider 
the  possibility  of  an  embolus  of  the  mesenteric  artery,  because  the 
pain  and  the  sudden  increase  in  his  pulse  rate  would  speak  for  an 
embolus."  However,  the  doctor  insisted  on  operating.  The  abdo- 
men was  opened  and  the  entire  intestinal  tract  was  found  gangTen- 
ous  from  an  embolus.  The  abdomen  was  closed  and  the  patient 
died.  Undoubtedly  experience  is  the  best  teacher,  but  forewa.rned 
ig  forearmed.  As  briefly  and  as  concisely  as  posisible  we  have  at- 
tempted to  visualize  the  salient  features  of  this  disease.  It  is 
neither  as  rare  as  some  nor  as  prevalent  as  othersi  would  lead  us  to 
believe.  At  the  Massachusetts  General  Hospital  where  there  are 
about  4,000  surgical  cases  yearly,  there  were  only  13  cases  of  this 
condition  in  12  years  (Sheahan,  Trans,  of  the  Sect,  on  Gen.  and 
Abd.  Surg,  of  the  A.  M.  A.,  1921,  p.  113)  and  at  the  LTniversity 
Hospital,  Balto.,  during  the  past  three  years,  where  ai^proximately 
2,000  operations  are  performed  yearly  only  the  two  cases  herein 
reported.  Loop  (Trans,  of  the  Sect,  on  Gen.  and  Abd.  Surg,  of 
the  A.  M.  A.,  1921,  102)  has  had  an  unusual  experience  mth  this 
malady.  He  saw  his  first  case  Jan.  28,  1918.  Since  then  he  has 
operated  on  eight  others,  with  1  recovery  and  8  deaths.  In  only 
two  did  he  suspect  mesenteric  thrombosis  as  a  probable  cause  of  the 
sickness  and  in  the  first  two  he  was  uncertain  as  to  the  cause  even 
after  the  belly  Avas  opened.     In  his  opinion  the  train  of  events  iu 


45 

the  acute  type  are  suiSciently  characteristic  to  make  a  preoperative 
diagnosis  possible.  He  presents  as  its  peculiar  syndrome;  sudden 
violent  abdominal  pain,  not  markedly  localized;  persistent  vomit- 
ing, usually  diminished  after  the  first  few  hours ;  slight  or  moder- 
ate fulness  of  the  abdomen  without  muscle  spasm,  and  a  dull  per- 
cussion note.  Certainly  the  picture  painted  isi  very  similar  to  the 
order  of  events  observed  by  us.  Admittedly  such  a  sequence 
whether  characteristic  or  not,  indicates  a  "surgical  abdomen,"  and 
demands  an  exploratory  laparotomy.  With  the  abdomen  opened, 
all  uncertainty  should  disappear.  Whilst  the  symptoms  might 
mimic  those  of  acute  appendicitis,  peritonitis,  acute  ileus,  intus- 
susception, volvulus,  ruptured  gastric  or  duodenal  ulcer,  the  patho- 
logical anatomy  most  assuredly  does  not.  The  significance  of  vari- 
able lengths  of  free  lying,  moderately  distended,  mahogany  tinted 
or  purplish-black,  glistening  bowel  should  no  longer  be  misinter- 
preted. It  is  the  pathological  sign-post  of  mesenteric  thrombosis, 
and  not  of  appendicitis,  peritonitis,  intussusception  or  any  other 
intraabdominal  disturbance.  Whilst  the  clinical  leaning  is  not  a 
matter  of  great  concern,  provided  the  existence  of  a  "surgical 
belly,"  is  promptly  appreciated;  a  correQt  interpretation  of  the 
operative  findings  is  of  the  utmost  importance,  if  the  patient  is  not 
to  be  deprived  of  his  only  chance  for  recovery.  Douglas  (Surgical 
Diseases  of  the  Abdomen,  1909,  2nd  Edit.,  p.  219)  certainly  is 
in  error  when  he  writes:  "Though  some  cases  run  a  surprisingly 
protracted  course,  all  are  certainly  fatal,  and  the  condition  appears 
to  be  beyond  remedial  measures."  When  the  disease  is  limited, 
the  operation  of  choice  is  resection  and  anastomosis  by  button  or 
suture.  If  the  patient  is  too  ill  to  withstand  so  protracted  an  or- 
deal the  gangrenous  segment  should  be  disposed  of  by  the  most 
expedititious  method  and  the  open  ends  tacked  to  the  margin  of 
the  skin,  with  a  latei'  restoration  of  the  continuity  of  the  bowel,  if 
the  patient  survive.  Each  of  these  methods  has  given  a  small 
number  of  recoveries.  When  practically  the  entire  small  and  a 
portion  of  the  large  bowel  are  involved,  the  condition  is  admittedly 
beyond  the  pale  of  surgery.  How  much  of  the  small  intestine  can 
be  removed  and  the  patient  survive  has  never  been  answered. 
Elliott  extirpated  four  feet  with  recovery  of  -the  patient.  This 
question  will  have  to  be  left  to  the  individual  judgment  of  the 
surgeon.  At  present  without  operation  100%  mortality  is  to  be 
expected,  with  operation  from  10  to  20%  cures.  Though  the  death 
rate  from  the  nature  of  the  malady  will  ever  be  appalling,  with 
greater  familiarity  the  percentage  of  cures  should  show  improve- 
ment. But  after  all,  its  prevention  is  ever  so  much  more  important 
than  its  cure.  Much  can  be  accomplished  in  this  line  by  the  use 
of  the  utmost  gentleness  in  the  handling  of  the  viscera  during 


46 

abdominal  operations  and  a  proper  course  of  treatment  in  those 
ailments  which  are  prone  to  vascular  occlusion  by  thrombi. 

Conclusions. 

1.  Mesenteric  thrombosis  is  relatively  more  common  than  sup- 
posed. 

2.  Cases  have  been  overlooked  through  unfamiliarity  with  its 
appearance,  by  confounding  it  with  other  diseases,  and  by  neglect- 
ing to  request  or  at  any  rate  to  obtain  an  autopsy  in  patients  dying 
with  intraabdominal  disturbances. 

3.  The  symptoms  are  only  suggestive,  but  the  pathology  is  dis- 
tinctive of  mesenteric  occlusion. 

4.  Prevention  is  ever  so  much  more  important  than  cure, 

5.  According  to  different  estimates,  the  percentage  of  cures 
range  from  10  to  20%  in  the  cases  subjected  to  early  operation. 

6.  1^0  acute  case  has  been  known  to  recover  without  operation. 

7.  It  is  a  possibility,  but  not  a  probability,  in  every  severe 
gastro-intestinal  crisis. 

THE   RELATIONSHIP    BETWEEN   ANO-RECTAL   AND 
CONSTITUTIONAL  DISEASES. 

G.  Milton  Linthicum,  A.  M.,  M.  D.,  F.  A.  C.  S., 
Professor  of  Proctology^  University  of  Maryland. 

The  relationship  between  ano-rectal  and  constitutional  diseases 
needs  be  considered  from  two  viewpoints ;  first,  rectal  diseases  may 
produce  constitutional  disturbances,  and  second,  general  condi- 
tions may  cause  alterations  within  the  large  gut. 

A  siui'vey  of  a  patient,  suffering  from  an  obscure  malady,  should 
include  a  rectal  examination.  Failure  to  employ  this  precaution 
means  the  neglecting  of  a  source  of  information  of  the  greatest 
importance.  It  is  equally  as  myopic  to  regard  rectal  disease  as  a 
separate  entity  with  no  bearing  on  constitutional  changes.  Nor- 
mally no  organ  of  the  body  functions  independently  of  the  other 
organs  and  it  of  necessity  follows  that  there  is  no  part,  whose' 
function  and  activity  is  interferred  with  by  disease,  which  does  not 
to  a  greater  or  less  degTeo  affect  other  parts  adversely.  As  in 
society  there  arc  individuals  closely  affiliated,  whose  activities  are 
reciprocally  affected  in  consequence  of  this  close  relationship;  so 
in  the  human  body  the  diseases  of  an  organ  affect  directly  the  other 
organs  of  the  same  system.  Carrying  this  argument  a  little  fur- 
ther, members  of  society  with  a  relationship  of  birth  are  J^till  more 
acutely  affected  by  the  activities  of  beneficence  or  malevolence 
than  others  less  close! v  rekted.    In  like  manner,  any  organ  of  the 


47 

same  embryological  origin  will  manifest  more  marked  symptoms 
when  one  or  the  other  is  injured.  An  excellent  exemplification  of 
this,  is  the  development  from  a  common  origin  (the  Wolffian  bodies 
and  the  Muellerian  ducts)  of  the  rectum  and  genito-urinary  sys- 
tem. In  consequence  of  this  an  ano-rectal  lesion  will  often  pro- 
duce bladder  or  prostatic  symptoms.  While  the  perversions  some- 
times found  further  establishes  this  close  nervous  connection. 

A  study  of  the  communicating  vascular  supply  of  the  rectum 
and  liver,  readily  explains  the  formation  of  internal  hemorrhoids, 
rectal  congestion,  as  well  as  hepatic  involvement  in  rectal  malig- 
nant growths. 

The  flow  of  the  lymph  through  the  inguinal  glands,  easily  ex- 
plains the  cause  of  adenitis,  developing  in  conjunction  with  an 
anal  lesion,  which  is  too  often  erroneously  regarded  as  having  a 
genital  origin. 

The  distribution  of  an  abundant  supply  or  sensory  nerves  to  the 
anal  canal  accounts  for  the  intense  pain  in  anal  lesions,  even 
though  the  lesion  may  be  comparatively  insignificant;  while  above 
the  anal  canal,  the  deficiency  of  sensory  nerves  permits  great  de- 
struction of  tissue  without  the  production  of  real  pain.  This  is 
the  reason  why  malignant  growths  may  go  on  to  the  point  of  break- 
ing down  without  its  presence  being  suspected  by  either  the  patient 
or  his  physician. 

Without  doubt  the  most  frequent  rectal  lesion  is  fistula.  At  St. 
Luke's  Hospital,  London,  an  institution  devoted  exclusively  to  the 
treatment  of  rectal  diseases,  one-third  of  their  dispensary  and  two- 
thirds  of  their  ward  cases  are  fistulae. 

Like  any  chronically  discharging  sinus,  the  fistula  in  aaio  has  a 
habit  of  invading  more  and  more  tissue.  This  phenomenon  is  ex- 
plained by  the  lowering  of  the  resistance  of  the  perirectal  tissues 
by  the  bacteria  or  their  toxins.  It  must  ever  be  borne  in  mind  that 
these  sinuses  by  affording  an  opportunity  to  bacterial  emboli  to 
enter  the  blood  stream  are  potential  foci  of  metastatic  arthritis  or 
even  valvular  heart  disease. 

This  is  not  an  inopportune  time  to  emphasize  the  true  relation- 
ship between  fistula  and  tuberculosis.  It  is  no  uncommon  occurrence 
to  hear  medical  men  make  the  statemnt,  90%  of  fistulae  are  tuber- 
cular. I  join  issue  with  this  extravagant  assertion.  From  my  own 
experience  and  the  observations  of  others,  qualified  to  expressi  an 
opinion,  I  believe  not  more  than  10%  of  these  fistulae  are  of  tulx^r- 
culousi  origin.  The  sallow,  pasty,  cacheictic  facies  of  an  individual 
with  a  long  standing  fistula.,  doubtlessly  is  largely  responsible  for 
this  wide-spread  impression.  Several  year's  ago  I  reviewed  the  clini- 
cal histories  of  about  twelve  hundred  cases  at  the  Maryland  Hospi- 
tal for  Consumptives  and  found  that  only  16  (1.3%)  had  or  had  had 


48 

a  fistula.  Of  this-  number  14  were  patients  classified  as  advanced  or 
hopeless  tuberculosis.  Of  1,000  tubercular  bodies  autopsied  in 
the  Munich  Hospitals,  566  showed  tuberculous  ulcerations  of  the 
intestines.  It  is  generally  admitted  that  primary  tuberculosis  of 
the  rectum  is  extremely  rare.  In  the  face  of  this  evidence,  I  be- 
lieve tbe  general  surgeon  of  the  past  erred  in  crediting  the  tubercle 
bacillus  with  such  an  important  role  in  the  production  of  fistula 
in  ano. 

In  a  considerable  number  of  a  small  group  of  ward  cases,  I  ob- 
tained a  positive  Wassermann,  consequently  I  think  syphilis 
should  be  given  consideration  when  seeking  the  cause  of  a  fistula 
in  ano. 

Hemorrhoids,  a  not  uncommon  rectal  involvement,  may  give  no 
constitutional  disturbances  and  one  may  even  go  through  life  un- 
conscious of  or  indifferent  to  their  presence.  On  the  other  hand, 
in  an  individual  of  less  phlegmatic  disposition,  the  nervous  equi- 
libriimi  may  be  entirely  shattered,  as  manifested  by  the  appear- 
ance of  all  sorts  of  reflex  phenomena,  viz.,  derangements  of  the 
gastric,  optic  and  mental  systems ;  and  under  the  stress  and  strain 
of  his  ills,  the  sufferer  becomes  a  neurasthenic  or  hypochondriac. 
The  continued  loss  of  blood  may  be  so  gTeat  as  to  produce  pro- 
found anemia  and  exhaustion.  When  painful,  to  the  other  nerve 
symptoms  is  added  constipation,  produced  by  the  dread  of  pain  at 
stool,  causing  delay  and  postponement  until  the  normal  rectal  re- 
flexes are  lost.  Hemorrhoids  are  often  the  sign-posts  of  intra- 
abdominal pressure  by  tumors,  of  obstructed  venous  circulation  in 
cirrhosis  of  the  liver  and  of  stasis  in  weakened  heart  conditions. 
Hemorrhoids  associated  with  enlarged  abdominal  veins,  forming  a 
crown  around  the  umbilicus  (caput  Meduspe")  are  almost  pathog- 
nomic of  a  contracted  liver.  High  blood  pressure  is  often  mani- 
fested and  sometimes  relieved  by  hemorrhagic  hemorrhoids.  In 
passing  it  might  be  well  to  state  that  such  bleeding  is  often  of 
marked  benefit,  acting  as  a  safety  valve  to  relieve  tension.  Such 
hemorrhoids  are  often  best  left  undisturbed.  The  sudden  appear- 
ance of  a  mass  of  piles  in  an  individual  not  hitherto  affected, 
is  suggestive  of  a  rectal  growth. 

Pruritis  ani  varies  from  the  pleasurable  sensation  derived  from 
scratching,  to  a  most  distressing  discomfort,  producing,  indeed,  in 
its  exaggerated  form  a  state  more  difficult  to  bear  than  actual  pain. 
Because  it  is  so  often  associated  with  diabetes  and  nephritis,  these 
diseases  should  alwa^'s  be  considered  as  a  possible  causative  agent. 

While  the  craze  is  on  for  the  removal  of  the  teeth,  in  search  for 
foci  of  infection,  the  small  crypts  around  the  anal  orifice  should 
be  borne  in  mind  as  possible  points  of  infection  and  should  be 
carefully  investigated  before  all  teeth  are  sacrificed. 


49 

Constipation. 

Voltaire  says  in  one  of  his  writings,  "Persons  who  have  an  easy 
and  regular  movement  every  morning  as  readily  as  one  spits,  after 
they  have  breakfasted,  are  the  favorites  of  nature.  They  are  sweet, 
affable,  gracious,  thoughtful,  complaisant  and  efficient,  a  no  in 
their  mouth  has  more  grace  than  a  yes  in  the  mouth  of  a  constipe." 

Hamilton  in  1805  gave  a  remarkable  list  of  diseases  caused  by 
constipation,  which  was  so  complete  and  extensive  that  few  have 
since  been  added. 

Lane  is  perhaps  the  most  ardent  of  present  day  authorities  in 
ascribing  pathological  conditions  to  constipation.  His  list  in- 
f'ludes  almost  every  known  disease  from  cancer  of  the  breast  to 
flat-foot.  He  states  that  the  harm  done  by  intestinal  stasis  is  in- 
finitely greater  and  more  far  reaching  than  that  ascribed  to  alcohol. 
In  a  similar  way  an  extraordinary  array  of  symptoms  were  as- 
cribed by  Hack  and  his  followers  to  tumefaction  of  the  nasal 
mucosa,  by  Bouchard  to  autointoxication  from  a  dilated  stomach 
and  by  Haig  to  uric  acid  poisoning.  It  is  quite  evident  that  while 
each  may  be  a  factor  in  some  cases,  there  is  no  condition  warrant- 
ing the  importance  attached  to  it  by  such  enthusiasts.  While  I 
believe  intestinal  stasis  is  responsible  for  more  discomfort  than 
any  other  non  mortal  disease,  I  cannot  agree  with  the  radical 
stand,  taken  by  Lane  in  a  recent  article  when  he  states,  that  after 
twenty  years'  experience  he  is  so  convinced  of  the  importance  of 
intestinal  stasis,  that  he  would  advise  the  removal  of  the  colon 
in  every  case  of  rheumatism,  goiter  and  Addison's  disease  when 
accompanied  by  such  sigTis  of  autointoxication  as  depression,  cold 
hands  and  feet  and  abdominal  discomfort,  if  the  stasis  is  confirmed 
l)y  the  X-ray. 

There  is  no  doubt,  that  constipation  causes  manifold  symptoms 
and  conditions.  The  peculiar  form  in  which  it  expresses  its  pres- 
ence depends  largely  upon  the  susceptibility  of  the  individual  and 
its  effects  are  as  variable  as  are  the  constitutions  of  different  peo- 
ple. This  individuality  can  no  more  be  explained  than  the  idiosyn- 
crasies of  susceptible  people  to  indiscretions  in  diet.  In  one  the 
dyscrasia  manifests  itself  as  hay  fever,  in  another  as  urticaria, 
in  still  another  as  eczema  and  in  yet  another  as  hypertension. 
This  mysterious  behaviour  is  called  anaphylaxis.  One  individual 
may  go  for  days  without  a  bowel  movement  and  feel  perfectly  well, 
as  illustrated  by  the  following  case  reported  by  Hurst,  a  French 
Army  Surgeon  had  always  been  constipated,  having  a  stool  about 
every  two  months,  until  he  reached  the  age  of  42  years  when  the 
frequency  had  diminished  to  two  or  three  a  year  fat  which  time 
it  was  doubtless  an  event  in  the  communitv).    He  had  alwavs  felt 


wBili_^€oiiad^  ^a^;^  good  appetite  until  the  age  of  54  when  he 
was  a^tancfe©^^^^"^mth  cramps  and  vomiting  from  which  he  died. 
Autopsy  showed  an  enormously  dilated  rectum  and  sigmoid,  the 
lumen  of  which  contained  60  lbs.  of  feces.  On  the  other  hand  the 
missing  of  a  daily  stool  will  cause  in  many  a  feeling  of  malaise, 
discomfort  and  headache.  To  what  to  ascribe  the  symptoms  pro- 
duced by  constipation  is  as  yet  an  unsettled  controversy,  and  while 
the  theory  of  absorption,  the  so-called  auto-intoxication,  is  now 
generally  accepted,  there  isi  no  doubt  but  that  the  mechanical  pres- 
sure against  the  contiguous  structures  by  accumulated  feces  does 
produce  by  pressure  upon  the  nerves  many  of  the  reflex  symptoms. 

Bacteriemia  is  today  of  exceedingly  great  interest  in  the  study  of 
kidney  lesions.  It  has  been  most  carefully  studied  by  Adami  who 
showed  that  the  intestinal  lymph  nodes  of  healthy  animals  always 
yield  cultures  of  the  same  bacteria  as  the  liver  and  spleen.  He 
found  that  these  organisms  were  carried  there  by  the  leucocytes 
through  the  lymphatics  to  the  blood  and  normally  were  destroyed 
in  the  liver  and  the  spleen,  but  when  either  Iw  lowered  resistance 
or  an  overload  of  bacteria  failed  to  accomplish  the  destruction  of 
these  germs,  they  were  eliminated  by  the  kidneys.  In  this  wise 
not  infrequently  is  the  origin  of  bacteriuria  and  pyelitis  to  be  ex- 
plained, even  pyelonephritis  should  there  be  a  blocking  of  the 
ureter  by  pressure,  kinking  or  stricture.  The  urine  of  normal 
individuals  contains  no  bacteria,  but  the  colon  bacillus  was  found 
in  three  of  twenty  constipated  cases  by  Dudgeon.  The  kidney  in- 
fection may  possibly  occur  by  direct  invasion  on  account  of  its 
nearness  to  the  colon.  The  infection  may  take  place  through  the 
lymphatics  especially  if  the  kidney  he  congested  from  a  kinking 
of  the  ureter  or  from  pressure  of  the  colon  against  it.  Adami 
believes  inflammations  of  the  genito-urinary  tract  of  the  nature  un- 
der discussion  may  be  the  foci  from  which  an  arthritis  or  a  rheu- 
matism may  take  its  origin.  Some  of  the  nervous  disturbances, 
such  as  backache  and  sciatica  are  due  to  direct  pressure  of  the 
distended  rectum  upon  the  sacral  plexus,  indeed  sciatica  was 
treated  at  the  end  of  the  18th  century  by  l^omnimus  of  ISTaples.  by 
washing  out  the  rectum.  Difficult  micturition  in  old  men  is  some- 
times due  to  the  pressure  on  an  enlarged  prostrate  by  fecal  accu- 
mulation. ISTocturnal  eneuresis  of  children  may  be  duo  to  n 
bacilluria,  to  fecal  pressure  on  the  neck  of  the  bladder,  or  to 
compression  of  the  four  sacral  nerves  which  control  the  bladder. 

Headaches  are  familiar  to  all  as  a  result  of  constipation,  as  is 
mental  and  physical  fatigue.  Infantile  convulsions  and  epilepsy 
are  often  inaugurated  by  intestinal  derangements.  That  reflexes 
either  from  pathological  changes  in  or  an  overloaded  rectum  do 
affect  the  heart  and  lungs,  through  the  recto-cardiac  and  recto- 


51 

respiratory  nervous  mechanism,  is  shown  by  the  increased  heart 
and  lung  activity  observed  when  the  anal  sphincter  is  being  dilated 
when  the  patient  is  under  an  anesthetic.  This  fact  should  be 
taken  cognizance  of  in  patients  suffering  with  asthma  or  heart 
lesions. 

Muco-membranous  colitis  is  always  associated  with  a  long  stand- 
ing constipation  found  in  nervous,  depressed,  irritable;  sometimes 
melancholic  individuals,  classified  as  neurasthenics.  Most  ob- 
servers contend  that  constipation  is  the  cause,  but  many  neurolo- 
gists look  upon  constipation  as  a  result  of  the  nerve  pathology.  A 
lengthy  discussion  of  these  divergent  views  would  be  without 
profit.  It  has  been  my  experience  that  relief  of  the  colitis  and  the 
associated  nervous  instability  is  contingent  upon  the  relief  of  the 
constipation  and  not  the  reverse.  In  the  meanwhile  sight  should 
not  be  lost  of  colitis  as  an  indication  of  the  presence  of  cancer  of 
the  colon.  This  is  a  sign  of  the  greatest  importance,  a  danger 
signal  of  malignancy  in  the  lower  alimentary  canal.  When  present 
carcinoma  must  be  considered  as  a  possibility  of  its  source. 

Conclusions. 

1.  Rectal  lesions  are  productive  of  constitutional  symptoms. 

2.  Eectal  disorders  may  be  a  manifestation  of  a  constitutional 
disease. 

3.  Reflexes  from  the  ano-rectal  region  may  produce  gastric  dis- 
turbances, or  in  rare  instances  have  a  direful  influence  upon  the 
heart  or  lung  action. 

4.  The  absorption  from  local  foci  or  fecal  stasis  may  produce 
infection  of  or  degenerative  changes  in  the  kidney  or  in  other 
organs,  or  may  so  lower  the  resistance  by  toxemia  that  the  indi- 
vidual is  more  susceptible  to  disease  and  is  a  poor  risk  in  a  serious 
illness  or  operative  procedure. 

5.  A  combination  of  intestinal  toxemia  and  reflex  disturbance 
may  result  in  a  general  upset  with  nervous  manifestations,  leading 
to  melancholia. 


Dr.  M.  M.  Savage,  who  has  been  attending  eye,  ear,  nose  and 
throat  courses  in  Vienna,  has  returned  to  his  home  in  Baltimore 
and  resumed  practice. 


52 

BOAED  OF  TEUSTEES  ENDOWMENT  FUND 
UNIVEESITY  OF  MAEYLAND. 

Eeport  of  B.  Merrill  Hopkinson,  M.  D.,  Treasurer, 

Covering  the  Period  January  12,  1920,  to  January  10,  1921. 

FACULTY  OF  PHYSIC  FUND. 

January  13,  1920,  balance  Central  Saings  Bank $557.92 

April  15,  1920,  interest  Central  Savings  Bank 5.27 

June  14,  1920,  James  Holmes,  M.  D 3,00 

June  14,  1920,  Hector  J.  Mac-Lean 5.00 

October  1,  1920,  interest,  Central  Savings  Bank 13.30 

Oct.  1,  1920,  LouisAdlle  Gas  and  Elec.  Co.  7%  Gold  Note  redeemed  1,000.00 

January  10,  1921,  interest  on  bonds  to  date 1,553.75 

$3,138.24 
Deduct : 

June  6,  1920,  Baltimore  County  5%%  Bond $1,013.73 

September  17,  1920,  Minneapolis  Coupon  Returned 25.00 

October   1,    1920,    1    1,000    Grand   Trunk.    Canada.    7% 

Debenture  Bond  and  interest 1,0(X>.94 

December  16,  1920,  Premium  Treasurer's  Bond 12.50 

2,053.17 

January  10,  1921,  balance  Central  Savings  Bank $1,085.07 

This  fund  consists  of: 

2  1.000  Am.  Agricul.  Chem.  Co.  5%  Bonds 1,963.06 

7  500     Cent.  Hudson  Gas  &  Elec  Co.  7%  Deben.  Bonds 3,500.00 

1  1.000  Ga.,  Car.  &  Northern  5%  Bonds 1,000.00 

5  500     Eegents  Univ.  of  Md.  5%  Bonds 2,500.00 

1  1,000  Pub.  Serv.  Corp.  of  N.  J.  5%  Bonds 1,000.00 

1  1.000  Minneapolis  Gas  Light  5%  Bonds 1,000.00 

1  1,000  Electric  Co.  Edison  5%  Bonds 1,000.00 

1  1,000  Fairmount  &  Clarksburg  Trac.  Co.  5%  Bonds 1,000.00 

1  1.000  Consol.  Gas  Co.,  Balto.  City,  41/2%  Bonds 980.00 

2  1.000  Omaha  &  Council  Bluffs  St.  Ry.  5%  Bonds 1,940.00 

2  1,000  Cincinnati  Gas  Trans.  Co.  5%  Bonds 1,960.00 

2  1.000  West  Pann  Power  Co.  5%   Bonds 1,940.00 

2  1,000  Cumberland  Co.  P.  &  L.  Co.  5%  Bonds 1,940.00 

1  500    First  Liberty  Loan  31/2% 500.00 

2  1.000  Louisiana  Port  Serial  Com.  5%  Bonds 2,000.00 

3  1,000  Third  Liberty  Loan  4%%  Bonds 3,000.00 

2  1,000  Fourth  Liberty  Loan  41/2%  Bonds 2,000.00 

1  nOO     Fourth  Liberty  Loan  41/0%  Bonds 500.00 

1  1.000  Balto.  Co.  5%%  Bond 1.000.00 

1  1 ,000  Grand  Trunk  of  Canada  7%  Bond 1,000.00 

$32,808.13 


53 

GENERAL  ENDOWMENT  FUND. 

January  12,  1920 — Baltimore  Central  Savings  Bank $955.74 

May  5,  1920 — Interest,  Central  Savings  Bank 9.50 

October  2,  1920— Interest,  Central  Savings  Bank 12.97 

January  10,  1921 — Interest  on  bonds  to  date 53S.75 

$1,516.96 
Deduct : 

May  26,  1920— Box  Colonial  Trust  Co $5.00 

July  6,  1920—1  1,000  Balto.  Co.  5%%  Bond  and  interest  1,013.74 

1,018.74 

January  10,  1921 — Balance  Central  Savings  Bank $498.22 

Tliis  fund  consists  of : 

1  500     Regents  Univ.  of  Md.  5%  Bond 500.00 

1  1,000  Ga.  and  Alabama  5%  Bond 1,000.00 

1  1,000  Ga.,  Car.  &  Northern  5%  Bond 1,000.00 

1  1,000  Omaha  and  Council  Bluffs  R.  &  B.  5%  Bond 1,000.00 

1  1,000  Consol.  Coal  Co.  6%  Bond 1,000.00 

2  500     Consol.  Co.  6%  Bonds 1,000,00 

2  1,000  St.  Jos.  Ry..  L..  II.  &  Power  Co.  5%  Bonds 2,000.00 

1  1,000  Edison  Elec.  Light  Co.  5%  Bond. 1,000.00 

1  500    First  Liberty  Loan  31/2%  Bond 500.00 

1  1,000  Third  Liberty  Loan  4%%  Bond 1,000.00 

1  500     Fourth  Liberty  Loan  414  %  Bond 500.00 

1  1,000  Baltimore  County  5%  %  Bond 1,000.00 


$11,998.22 


LAW   FUND. 

January  12,  1920— Balance  Central  Savings  Bank $161.4S 

April  1,  1920— Interest,  Central  Savings  Bank 1.60 

October  1,  1920— Interest,  Central  Savings  Bank 3.20 


$166.23 


PHARMACY  FUND. 

January  12,  1920— Balance  Central  Savings  Bank $20.05 

April  1,  1920— Balance  Central  Savings  Bank .20 

May  26,  1920— Henry  I'.  Ilynson.  Ph.  D 25.00 

<  October  1,  1920 — ^Interest,  Central  Savings  Bank .73 

$45.98 


L 


64: 

RANDOLPH  AVINSLOW  FUND. 

Junuary  12,  1920— Balance  Central  Savings  Bank .$68.91 

April  1,  1920— Interest,  Central  Savnigs  Bank .65 

Octber  1,  1920— Interest,  Central  Savings  Bank -      .50 

January  10,  1921 — Interest  on  bonds  to  date 125.00 

$195.06 
Deduct : 

June  17,  1920— Scholarship  N.  de  Cordona,  $125.00  125.00 

January  10.  1921— Balance  Central  Savings  Bank $70.06 

This  fund  consists  of : 

-5  .500  Regents  Univ  of  Maryland  5%  Bonds 2,500.00 


$2,570.06 

DAVID  STREETT  SCHOLARSHIP  FUND. 

March  10.  1920— Reed,  from  Randolph  Winslow,  M.  D.,  Chk.  4447  $17.88 

October  1,  1920 — Interest,  Central  Savings  Bank .40 

January  10,  1921— Interest  on  Bonds  to  date 36.88 

•Tanuary  10.  1921— Balance  Central  Savings  Bank $35.16 

This  fund  consists  of  the  following  bonds : 

Received  from  Randolph  Winslow,  M.  D.,  March  10,  1920: 

8  100  First  Liberty  Loan  41/2%  Bonds ,$300.00 

1  100  Second  Liberty  Loan  4%%  Bond 100.00 

1  50     Fourth  Liberty  Loan  4i/4%  Bond 50.00 


$485.16 


HEMMETER  FUND. 

.lanuary  12,  1920 — Balance  Central  Savings  Bank $555.25 

April  1,  1920— Interest,  Central  Savings  Bank 8.32 

October  1,  1920— Interest.  Central  Savings  Bank 18.72 

January  1,  1921 — Interest  on  bonds  to  date 496.85 


I  )educt : 
Oct.  2,  1920—1  1000  (irand  Trunk  of  Canada  7%  Bond  &  Int. 


$1,079.14 
1.001.94 


January  10,  1921— Balance  Central  Savings  Bank .$77.20 

This  fund  consists  of: 

1  1,000  Chicago  City  Bond  5% 1.000.00 

1   1,000  Chicago  Railway  Bond  5% 1,000.00 

1  1.000  Minneapolis  St.  Ry  &  St.  Paul  Ry  5% 1,000.00 

2  1 .000  Third  Liberty   Loan  4 Vi  % 2,000.00 

i  1,(100  Grand  Trunk  of  Canada  7%  Bond 1,000.00 


$6,077.20 


55 

CHARLES  FRICK  FUND. 

January  12,  1920 — Balauce  Central  Savings  Bank .$366.50 

April  15,  1920— Interest  Central  Savings  Bank 3.65 

October  1,  1920 — Interest  Central  Savings  Bank 7.57 

.Tamiary  10,  1921 — Interest  on  Bond  to  date 21.25 

January  10,  1921 — Balance  Central  Savings  Bank $398.97 

This  fund  consists  of : 

1  500  Fourth  Liberty  Loan  414% 500.00 

$898.97 

LEON  FRANK  FUND. 

January  12,  1920— Balance  Central  Savings  Bank $114.29 

May  5,  1920 — Interest  Central  Savings  Bank 1.07 

October  1.  1920— Interest  Central  Savings  Bank 1.42 

January  10,  1921 — Interest  on  Bonds  to  date 125.00 

$241.78 
Deduct : 

June  17,  1920— Scholarship  J.  II.  Wilkerson,  $125.00 125.00 

January  10,  1921 — Balance  Central  Savings  Bank $116.78 

This  fund  consists  of : 

1  500     Cen.  Hudson  Gas  &  Elec.  Co.  1%  Deben.  Bonds,  15  years.  500.00 

1  1,000  St.  Jos.  IL,  L.  &  P.  Co 1,000.00 

1  1,000  Omaha  &  Coun.  Bluffs  R.  &  B 1,000.00 

$2,616.78 

CHAS.  M.  HITCHCOCK  FUND. 

January  12,  1920— Balance  Central  Savings  Bank $205.58 

April  1,  1920— Interest  Central  Savings  Bank 2.05 

October  1,  1920— Interest  Central  Savings  Bank 2.43 

January  10,  1921— Interest  on  bonds  to  date 250.00 

$460.06 
Deduct : 

June  17,  1920— Scholarship,  J.  J.  Krager $125.00 

June  17,  1920— Scholarship,  D.  N.  Ingram 125.00 

250.00 

Balance  Central  Savings  Bank $210.06 

This  fund  consists  of: 

10  500  Regents  I'niv.  of  Md.  57c  Bonds • 5,000.00 

$5,210.00 


56 

KATHERINE  GIBSON  FUND. 

January  12,  1920— Balance  Central  Savings  Bank $526.29 

April  15,  1920 — Interest  Central  Savings  Bank 5.25 

October  1,  1920— Interest  Central  Savings  Bank 11.02 

January  10,  1921 — Balance  on  Bonds  to  date 71.25 

January  10,  1921— Balance  Central  Savings  Bank $613.81 

This  fund  consists  of: 

2  500  Regents  University  of  Maryland  5%  Bonds 1,000.00 

1  500  Fourtli  Liberty  Loan  4i/4%  Bond 500.00 


$2,113.81 


DENTAL  FUND. 

January  12,  1920— Balance  Central  Savings  Bank $24.20 

April  1,  1920— Interest  Central  Savings  Bank .20 

October  1,  1920— Interest  Central  Savings  Bank .40 

January  10,  1921— Balance  Central  Savings  Bank 24.80 


TOTAL  PAR  VALUE  ON  BOOKS  OF  ALL  FUNDS. 

Faculty  of  Physic  Fund $32,808.13 

General  Endowment  Fund 11,998.22 

Leon  Frank  Fund 2,616.78 

Charles  M.  Hitchcock  Fund 5,210.06 

Hemmeter  Fund  6,077.20 

Charles  Frick  Fund , 898.97 

Randolph  Winslow  Fund 2,570.06 

Katherine  Gibson  Fund 2,113.81 

David  Streett  Scholarship  Fund 485.16 

Law  Fund  166.23 

Pharmacy  Fund   45.98 

Dental  Fund  24.80 


65,015.40 


B.  Meeeill  Hopkinson,  M.  D., 

Secretary-Treasurer. 


January  10,  1921. 


5T 

EDITOEIAL. 

Medical  Extension  Courses. 

On  December  1,  1921,  the  Medical  School  of  the  University  of 
Maryland  inaugurated  a  new  and  far-reaching  policy.  On  that 
date  the  first  lecture  was  given  in  the  medical  extension  course.  It 
partook  of  a  clinical  talk  by  Dr.  Lewellys  F.  Barker  on  the  sple- 
nomegalias  with  an  exhibition  of  a  case  of  Banti's  disease  conva- 
lescing from  a  splenectomy.  The  clinic  was  given  in  Chemical 
Hall,  Administration  Building,  and  its  popularity  was  attested  by 
the  hall  being  crowded  to  overflowing.  At  the  second  clinic,  held 
December  8,  the  subject  was  diabetes  mellitus.  A  case  was  ex- 
hibited. This  patient,  a  woman  of  middle  age,  was  about  to  go 
into  diabetic  coma  when  she  was  admitted  to  the  University  Hos- 
pital but  under  the  approved  methods  of  treating  this  disease  had 
become  sugar  free.  She  was  presented  as  an  example  of  what 
modern  methods  can  do  in  the  way  of  prolonging  the  life  of  the 
victims  of  this  malady.  Dr.  Barker  said  in  the  dietary  manage- 
ment of  these  cases,  the  fats  should  be  the  first  article  of  diet 
restricted,  then  the  proteins  and  last  of  all  the  carbohydrates.  The 
progress  of  the  patient  he  measures  by  analyses  of  the  blood  for 
the  sugar  percentage,  the  urine  and  the  carbon  dioxide  tension  of 
the  alveolar  air  and  carbon  dioxide  in  the  blood  plasma.  After 
the  patient  has  been  rendered  sugar  free,  the  first  article  of  diet 
to  be  restored  is  the  carbonhvdrate,  then  the  protein,  and  last  of 
all  the  fat.  At  least  once  a  week  the  patient  should  observe  a  fast 
day.  If  acidosis  impends  he  especially  interdicted  the  use  of 
bieardonate  of  soda,  instead  he  said  rather  employ  large  quantities 
of  water  and  get  it  into  the  body  by  whatever  route  feasible.  The 
talk  was  well  received  by  a  large  and  enthusiastic  audience,  men 
and  women  from  all  over  the  State,  and  forbodes  continued  inter- 
est in  the  series  so  auspiciously  begun.  The  course  is  designed  for 
the  instruction  of  lioth  doctors  and  laymen  and  in  a  way  is  some- 
what similar  to  the  extension  service  carried  on  by  the  agricultural 
department  of  the  University.  As  the  work  becomes  more  firmly 
established  the  service  will  be  broadened  by  providing  special 
courses  in  the  counties.  Health  clinics  by  the  professional  staffs 
of  the  University  of  Maryland-  are  planned  for  commimities  so 
situated  that  the  residents  cannot  arrange  to  come  to  Baltimore. 
Demonstrators  of  special  training  and  experience  will  be  sent  into 
rural  districts  to  elucidate  problems  essential  to  the  maintenance 
of  individual  and  community  well  being.  The  departure  is  a 
new  and  radical  one  from  which  much  good  ought  to  accrue  both  to 
the  University  as  well  as  the  general  public.  Heretofore  the  Gov- 
ernment has  expended  huge  sums  in  the  preservation  of  pigs, 
cattle,  poultry,  fruits  and  crops,  and  now  it  turns  in  but  a  humble 


58 

Avay  to  the  conservation  of  its  greatest  asset  of  all,  its  people.  The 
idea  is.  in  the  experimental  stage  as  yet,  bnt  when  under  f  nil  opera- 
tion is  franght  with  nnlimited  possibilities  for  good.  In  the  final 
analysis  an  institution  like  an  individual  only  justifies  its  exist- 
ence by  the  measure  of  good  it  accomplishes.  Its  meed  of  useful- 
ness is  measured  by  the  amount  of  service  it  renders  the  commu- 
nity it  serves. 


ANNOUNCEMENT. 

A  Course  in  Diseases  of  the  Eye,  Ear,  Nose  and  Throat  for 
THE  General  Practitioner. 

During  the  month  of  April,  the  Division  of  Medical  Extension 
<jf  the  University  of  Maryland  will  offer  to  physicians  an  intensive 
short  course  in  Diseases  of  the  Eye,  Ear,  ISTose  and  Throat. 

For  a  long  time  a  course  of  this  character  has  been  needed  to 
give  to  the  physician  in  general  practice  an  opportunity  to  acquaint 
himself  with  recent  developments  in  diagTiosis  and  treatment  in 
this  field. 

This  is  not  a  course  for  specialists,  but  is  arranged  for  the  gen- 
eral medical  man.  Emphasis  will  be  laid  upon  training  in  the 
use  of  such  aids  in  diagnosis  and  treatment  as  the  ophthalmoscope 
otoscope,  laryngoscope,  bacteriological  smears  and  cultures,  the  in- 
terpretation of  X-ray  plates,  the  therapeutic  uses  of  radium,  etc. 
In  lectures,  clinics  and  dispensary  classes  there  will  be  offered  a 
brief  review  of  the  Anatomy,  Pathology  and  Bacteriology  of  the 
Eye.  Ear,  l^ose  and  Throat,  and  a  systematic  presentation  of  the 
fundamentals  in  the  clinical  features  and  the  treatment  of  the 
commoner  diseases  of  the  Eye,  the  Paranasal  Sinuses,  the  !N"ose 
and  Throat,  and  the  Ear  and  Associated  Structures.  The  present 
conception  of  the  relationship  of  pathological  processes  in  the  nose 
and  throat,  and  eye  and  ear  to  general  health,  to  faulty  develop- 
ment in  childhood  and  to  certain  systemic  diseases,  such  as 
arthritis,  endocarditis,  nephritis,  etc.,  will  be  defined  in  a  series  of 
lectures  by  members  of  the  Departments  of  Medicine.  Surgery. 
Orthopedics,  Pediatrics,  etc. 

As  the  course  is  to  be  limited  to  one  month,  a  full  schedule  will 
be  arranged  running  from  9  A.  M.  to  5  P.  M.  The  schedule  will 
be  announced  later. 

Charges — The  course  will  be  free  of  charge  to  "Maryland  physi- 
cians, except  for  a  Pegistration  Fee  of  Five  Dollars  to  pay  for 
actual  cost  of  printinc.  stamps,  incidentals,  etc.  For  physicians 
from  other  States  a  nominal  fee  will  be  charged. 

As  the  course  will  bo  limited  to  ten  men,  applications  should  be 
sent  promptly. 

Address:  Dr.  T.  M.  R.  Powland,  Dea/r. 

Univcrftifi/  of  Mnrylnnd  Mpfficnl  Srhooh 


59 


BOOK  REVIEWS. 

Collected  Papers  of  the  Mayo  Clinic,  Eochester,  Minn.  1920. 
Octavo  of  1392  Pages,  446  Illustrations.  Philadelphia 
and  London:    W.  B.  Saunders  Company.     Cloth,  $12  net. 

The  collected  papers  of  the  Mayo  Clinic,  now  in  the  12th  \oI- 
ume,  need  no  introduction  to  the  medical  profession.  The  amount 
of  work  done  in  this  clinic  is  outstanding  in  merit  and  diversity 
and  the  conclusions  are  based  on  such  a  wealth  of  material  that 
they  are  authoritative.  From  such  a  wealth  of  reports  it  is  impos- 
sible to  pick  out  any  single  one  and  say  that  it  is  more  meritorious 
than  its  fellows.  The  professipn  is  indeed  fortunate  to  have  these 
contributions  collected  together  in  a  single  volume  and  no  pro- 
gressive surgeon  can  afford  to  be  without  it,  as  it  is  a  clinical 
laboratory  of  inestimatable  value.  Listen  to  a  partial  list  of  the 
articles  and  then  judge  for  yourself:  A  Method  of  Applying 
Radium  in  Cases  of  Esophageal  Cancer,  Surgical  and  !N"on-Surai- 
cal  Aspects  of  Chronic  Gastric  and  Duodenal  ITlcers,  Studies  in 
the  Physiology  of  the  Liver,  Cholecystectomy  with  Modified 
Drainage,  Diverticulitis  of  the  Large  Bowel,  Occluded  Renal 
Tuberculosis,  Vesico-Appendiceal  Fistulas,  the  Surgical  Treat- 
ment of  Malignant  Tumors  of  the  Bladder,  Conservation  of  the 
Menstrual  Function,  Malignant  Tumors  of  the  Thyroid,  Cysts  of 
the  Pancreas,  the  Present  Status  of  Splenectomy  as  a  Therapeutic 
Measure,  the  Treatment  of  Pernicious  Anemia  by  Splenectomy, 
Hemolytic  Icterus,  Surgery  of  Spinal  Cord  Tumors,  Abscess  of  the 
Lung,  Tumors  of  the  Bony  Chest  Wall.  Each  and  every  one  of 
these  is  a  live  question,  a  question  of  interest  to  not  only  the 
surgeon  but  also  to  the  practitioner  of  internal  medicine.  There 
is  no  such  thing  as  a  purely  medical  condition  or  a  purelv  surgical 
disease,  any  disease  which  is  the  one  is  at  any  time  liable  to  pass 
over  into  the  realms  of  the  other,  therefore  it  is  now  more  incum- 
bent than  ever  that  the  specialist  and  general  practitioner  be 
broadlv  acquainted  with  the  problems  of  each  other.  We  can 
truthfully  say  that  this  book  will  prove  an  indispensable  and  in- 
valuable guide  upon  a  host  of  subjects  to  all  who  practice  medicine. 

Tlie  Spleen  and  Some  of  Its  Diseases.     By  Sir  Berkeley  Movni- 
ham.  of  Leeds.  England.      129   Paaes  with   18  full  pace 
Diagrams.      Philadelphia   and   London:    W.   B.    Saunders 
■    Company,  1921.     Cloth,  $5  net. 

I'^ntil  within  very  receiit  times  the  spleen  has  been  a  tabooed 
organ. surgically.     Occasionally  it  was  removed  when  irreparably 


60 

damaged  by  injury  and  sporadically  for  eulargements  of  one  sort 
or  another.  During  the  past  few  years  quite  a  surgery  of  this 
organ  has  developed  and  the  spleen  has  been  extirpated  for  spleno- 
myelogenous  leukemia,  Banti's  disease,  hemolytic  jaundice,  per- 
nicious anemia,  cirrhosis  of  the  liver,  etc.  Moyniham  himself 
has  played  a  prominent  role  in  this  development.  Scarcely  any- 
body alive  has  had  a  gTeater  or  more  varied  experience  with  the 
surgery  of  the  spleen.  Therefore  anything  from  his  pen  must  bear 
the  weight  of  authority  and  be  greedily  absorbed  as  the  last  word 
upon  the  subject.  As  long  ago  as  the  middle  of  the  last  century 
it  was  clearly  established  by  experience  which  was  beyond  cavil 
that  the  spleen  was  an  organ  not  necessarily  present  in  normal 
individuals,  that  its  removal,  when  successful,  did  not  seriously 
impair  the  chances  of  life  and  of  good  health,  and  that  after  its 
removal  certain  changes  assumed  to  be  of  a  compensatory  char- 
acter followed  in  due  course.  The  way  was  then  prepared  for  the 
deliberate  removal  of  the  spleen  from  man  in  conditions  in  which 
it  was  enlarged  by  disease.  The  first  instance  of  such  an  operation 
is  related  by  Quittenbaum,  in  1826,  who,  after  a  series  of  experi- 
ments in  which  the  spleen  was  successfully  removed  from  cats 
and  dogs,  undertook  the  removal  of  the  organ  from  a  human  being. 
The  patient  was  a  woman  suffering  from  cirrhosis  of  the  liver  and 
ascites.  She  survived  the  operation  only  six  hours.  The  first 
splenectomy  deliberately  performed  in  England  for  an  enlarge- 
ment of  the  organ  was  done  by  Spencer  Wells.  The  patient  was 
a  woman,  34  years  of  age,  who  was  evidently  dying  from  a  large 
spleen,  and  who  had  no  other  disease.  The  patient  died  of  septi- 
cema  6I/2  days  after  the  operation.  There  was  not  much  advance 
in  splenic  surgery  from  Wells'  time  until  the  last  few  years  when 
splenectomy  came  into  use  in  the  treatment  of  certain  of  the 
anemias  associated  with  splenomegaly.  According  to  Moyniham 
the  work  done  at  the  Mayo  Clinic  along  this  line  shows  better  than 
any  other  record  the  modern  position  of  the  operation  of  sple- 
nectomy. 

SPLENECTOMIES   FOR   SPLENIC  ANEMIA. 

Total  iiiunbei-  of  cases  to  September  20.  1920 73 

Total  number  of  hospital  deaths 9=12.3% 

The  results  in  spenic  anemia,  generally  speaking,  have  l">een 
good,  but  the  opcrntion  is  more  difficult  than  in  other  conditions, 
and  the  mortality  is  considerable. 


61 

SPLENECTOMIES  FOR  PERNICIOUS  ANEMIA. 

Total  number  of  cases  to  September  20,  1920 53 

Total  mimber  of  hospital  deaths 3=5.6% 

In  early  cases  at  least  the  operation  is  justifiable. 

SPLENECTOMIES  FOR  MYELOGENOUS  LEUKEMIA. 

Total  number  of  eases  to  September  20,  1920 26 

Total  number  of  hospital  deaths 1=3.8% 

The  results  are  poor  in  myelogenous  leukemia,  but  five  patients 
are  in  good  condition  and  two  in  fair  condition  after  periods  of 
time  beyond  the  life-expectancy  of  these  cases.  The  patients  are 
at  least  relieved  of  the  weight  of  the  spleen,  and  in  two  in- 
stances supposed  to  be  early  cases  of  myelogenous  leukemia,  not 
counted  in  this  series,  the  patients  have  been  cured,  or  at  least 
they  have  lived  a  number  of  years  following  the  operation.  The 
operation  is  .not  difiicult  after  radium  treatment,  and  in  selected 
cases  should  be  further  considered. 

SPLENECTOMIES  FOR  HEMOI;YTIC  JAUNDICE. 

Total  number  of  cases  to  September  20,  1920 32 

Total  number  of  hospital  deaths 1=3.1% 

The  results  in  hemolytic  icterus  have  been  excellent.  Spenec- 
tomy  is  a  real  cure  in  a  high  percentage  of  cases. 

SPLENECTOMIES  FOR  SEPTIC  SPLENOMEGALIAS.      • 

Total  number  of  cases  to  September  20,  1920 10 

Total  number  of  hospital  deaths 2=20% 

Splenectomy  is  undoubtedly  indicated  in  some  of  these  cases: 

Diagnosis.  No.  of  Cases.    Hospital  Deaths. 

Portal  cirrhosis 9  4 

Biliary  cirrhosis  6  1 

Lymphoma 3  0 

Luetic  spleuomegalias  6  1 

Lymphosarcoma 2  0 

Gaucher's  disease   4  1 

Tuberculosis 4  0 

Wandering  spleen 2  0 

Splenomegal.v  with  eosinophilia 1  0 

Splenomegaly  with  neutrophilia 1  1 

Miscellaneous,  questionable  11  2 

Thus  the  number  of  cases  is  243,  with  26  hospital  deaths. 


62 

Despite  the  great  amount  of  experimental  work  done  on  the 
spleens  of  animals  and  the  ever  increasing  observation  upon  the 
splenectomized  man  but  little  positive  has  been  evolved  concern- 
ing its  functions  or  the  part  it  plays  in  the  human  economy. 
Though  it  is  an  organ  with  gTeat  pathological  potentialities,  it 
appears  to  have  no  function  of  sufficient  importance  to  be  dis- 
turbed by  its  removal.  W.  J.  Mayo  claims  that  the  function  of  the 
spleen  is  in  direct  relation  with  the  liver,  shown  by  the  fact  that 
whatever  the  function  of  the  spleen  may  be,  it  is  unable  to  com- 
plete the  work  that  it  initiates.  Moyniham  discusses  in  his  pecu- 
liar style  the  possible  functions  of  the  spleen,  but  proves  nothing 
definitely.  Leaving  us  in  the  same  position  we  have  been  in  for 
some  time  past,  that  is  its  property  of  destroying  deteriorated  red 
cells,  its  sifting  action  upon  microorganisms  and  its  elaboration  of 
hormones  which  act  on  organs  at  a  distance,  especially  the  bone- 
marrow. 

This  book  brings  such  facts  asi  are  known  concerning  the  func- 
tions, pathology,  and  treatment  of  distempers  of  the  spleen  to- 
gether in  a  most  agreeable,  interesting  and  fascinating  manner.  Tt 
tells  how  such  meagre  truths  as  are  known  have  been  v/rung  by 
animal  experimentation  and  clinical  observation  out  of  the  maze 
of  fantasies  enshrouding  this  organ.  The  story  is  a  remarkable 
one  of  perseverence  and  continued  mass  effort,  and  the  conquests 
of  the  recent  past  are  but  an  earnest  of  more  rapid  progress  in 
the  future.  The  spleen  is  ever  claiming  more  anrl  more  attention 
of  the  medical  profession.  Those  desirous  of  obtaining  a  jus^" 
estimate  of  the  part  it  is  playing  in  the  provocation  and  develop- 
ment of  morbid  processes  within  the  body  will  find  in  this  book  of 
Moynihan's  the  information  for  which  they  are  seeking.  Surgeons 
and  physicians  alike  will  find  it  most  helpful. 

Pitfalls.  By  A.  J.  Caffrey,  M.  D.,  Instructor  in  Physiology  at 
Milwaukee  Medical  College,  from  1901  to  1910,  Assistant 
Professor  of  Medicine  at  Marquette  University  School  of 
Medicine,  from  1913  to  1920.  Boston :  Bichard  G.  Badger, 
1021.     Cloth,  $2  net. 

From  the  days  of  Hippocrates  the  mistakes  in  medicine  have 
lieen  more  of  omission  than  of  commission.  A  diagnosis  implies 
the  expenditure  of  much  effort  in  the  solution  of  the  nature  of  the 
disease  at  fault.  Sometimes  the  evidence  poinis  directly  to  the 
disease  and  the  diagnosis  is  made  with  somewhat  less  effort  than 
in  more  obscure  maladies,  but  a  diagnosis  to  be  of  value  must 
always  be  the  result  of  a  careful  balancing  of  the  history,  physical 
and  iaboratorv  findinc,s.    In  some  cases  the  history  is  the  most  im- 


63 

portant  link  iu  the  chain  leading  up  to  a  diagnosis,  at  other  times 
the  exact  malady  can  only  be  determined  by  the  physical  examina- 
tion and  on  other  occasions  a  solution  of  the  problem  can  be  made 
by  the  laboratory  alone.  Even  after  the  exertion  of  the  greatest 
care  a  mistaken  diagnosis  may  be  arrived  at.  Under  such  cir- 
cumstances the  error  is  not  to  be  held  against  the  doctor.  He 
has  used  due  care  and  foresight.  But  another  class  of  mistakes 
is  not  to  be  condoned,  viz.,  the  snap-shot  diagnosis.  An  opinion 
of  this  sort  is  an  admission  of  ignorance  pure  and  simple,  a  dis- 
play of  lack  of  knowledge.  In  Pitfalls  many  instances  of  mis- 
takes of  the  latter  type  arc  recorded.  To  drive  the  lesson  home 
with  greater  force  Caffrey  has  made  use  of  a  series  of  stories  as 
tJie  exploiting  medium.  The  experiences  related  therein  are  real. 
This  gives  the  book  greater  pungency.  Whilst  the  book  is  written 
iu  a  popular  vein,  the  style  in  no  wise  detracts  from  its  usefulness. 
The  mistakes  enmnerated  may  seem  ludricrous,  withal  they  arc 
made  every  day  by  each  and  every  one  of  us.  Their  airing  cannot 
help  but  in  the  end  be  productive  of  much  good.  It  is  well  worth 
the  reading  both  by  the  profession  and  by  the  laity. 

Manual  of  Operative  Surgery.  By  John  Fairbairu  Biunie,  A.  M.. 
C.  M.  (Aberdeen)  ;  F.  A.  C.  S.,  Surgeon  to  the  Christian 
Church,  The  Research  and  the  General  Hospital,  Kansas 
City,  IMo. :  Fellow  of  the  American  Surgical  Assciation : 
Member  de  Societe  International  de  Chirurgie;  Member 
of  the  Western  Surgical  Association.  8th  Edition,  revised 
and  enlarged  with  1628  illustrations,  a  number  of  which 
are  printed  in  colors.  Philadelphia,  P.  Blackiston's  Son 
&  Co.,  1921. 

The  fact  that  this  book  has  reached  its  8th  edition  attests  its 
popularity.  It  is  popular  because  it  differs  from  other  text-books 
on  operative  surgei*y,  inasmuch  as  emphasis  is  laid  upon  unused 
rather  than  upon  the  common  operative  procedures.  While  ex- 
tensive requisitions  have  been  made  on  the  work  of  foreign  authors, 
the  book  is  to  a  large  extent  an  epitome  of  the  most  modern 
methods  of  the  leading  American  surgeons  and  as  such  will  com- 
mend itself  to  American  students  and  practitioners.  The  typogra- 
]ihy  of  the  book  is  good  and  the  illustrations  excellent.  We  have 
no  hesitation  in  recommending  it  as  a  standard  work  on  operative 
surgery. 


64 


ITEMS. 

Dr.  Edjar  Perkins,  of  the  Rochambeau  Apai'tments,  Baltimorey 
Md.,  is  a  patient  in  the  University  HospitaL 

Dr.  M.  M.  Savage  writes  Dr.  Charles  Emil  Brack  from  Vienna, 
Austria,  under  date  of  October  2,  1921 :  I  have  been  in  Vienna 
since  August  15,  1921,  once  more  leading  an  arduous  student  life 
and  attending  eye,  ear,  nose  and  throat  courses  and  clinics  offered 
to  American  physicians,  the  best  that  are  given  anywhere  at  pres- 
ent in  Europe.  In  the  antebellum  days  the  medical  men  of 
America  would  divide  their  time  between  Berlin  and  Vienna. 
Unfortunately  the  Berlin  Medical  Faculty,  and  for  that  matter 
the  faculties  of  the  other  great  medical  centers,  either  from  the 
fact  that  they  have  not  forgotten  that  through  America  they  lost 
the  war,  or  for  other  reasons,  look  upon  the  American  doctor  as  a 
persona  non  grata,  with  the  result  that  but  few  of  our  boys  are  now 
in  Berlin.  There  are  about  fifty  American  physicians  at  present 
in  Vienna,  and  we  have  our  own  A.  M.  A.,  of  Vienna.  Before  the 
war  the  membership  ran  up  to  300  at  one  time.  Most  of  the 
men  here  attend  the  eye,  ear,  nose  and  throat  clinics.  Dr.  J.  G. 
O'Brein,  class  of  1916,  is  here  attending  otological  clinics. 

Dr.  St.  Clair  Streett,  class  of  1880,  is  a  resident  of  Kansas  City, 
Missouri.  He  was  born  in  Harford  County,  Md.,  and  is  a  son  of 
the  late  John  Rush  Streett.  He  went  to  Kansas  City  in  1882 
since  which  time  he  has  succeeded  in  reaching  much  prominence 
in  his  adopted  city.  During  the  World  War  he  was  a  major  in 
the  Medical  Corps  whence  he  severed  his  connection  in  1919.  He 
is  62  years  old. 

Drs.  Randolph  Winslow,  Alexius  McGlannan,  Harvey  Stone, 
Isaac  S.  Stone,  Lloyd  ISTolan  and  Nathan  Winslow  attended  the 
34th  Annual  Session  of  the  Southern  Gynecological  Association 
held  at  Pinehurst,  Is^.  C,  December  13,  14,  15,  1921.  The  presi- 
dent, Dr.  Randolph  Winslow,  according  to  the  usual  custom,  de- 
livered the  presidential  address.  He  spoke  on  the  Retrospect  and 
Prospect  of  the  Society.  Dr.  IN'olan  read  a  paper  entitled  "Con- 
tracture of  the  Psoas  Parvus  as  an  Explanation  of  Obscure  Al> 
dominal  Pain  in  Certain  Cases;  Dr.  McGlannan,  Meckel's  Di- 
verticulum; Dr.  Han^ey  Stone,  Operation  for  Diaphragmatic 
Hernia,  combined  Abdominal  and  Thoracic  Approach  ;  Dr.  Isaac  S. 
Stone,  Primary  Carcinomai  of  the  Female  Bladder,  and  Dr. 
ISTathan  Winslow,  by  invitation.  Aneurism  of  the  Extra-Cranial 
Portion  of  the  Internal  Carotid  Arters'. 


UNIVERSITY  OF  MARYLAND 

BULLETIN 

OF   THE 

SCFiOOL  OF  MEDICINE 

Vol.  VI.  APRIL,   1922.  No.  4 

CERVICAL  RIBS. 
By  Joseph  W.  Holland,  M.  D.,  F.  A.  C.  S. 

Practically  all  Mammalia  have  seven  cervical  vertebrae.  There 
are  a  few  known  exceptions,  e.  g. :  one  variety  of  sloth  has  but 
six  while  another  variety  has  nine.  It  may  be  mentioned  that  the 
latter  variety  has  ribs  attached  to  the  ninth  cervical  vertebra  and 
frequently  also  to  the  eighth. 

The  manatee  has  only  six  cervical  vertebrae.  In  certain  species 
of  the  whale  the  cervical  vertebrae  are  fused  but  bear  separate 
transverse  processes.  The  giraffe  has  but  seven  vertebrae  in  the 
neck.  The  Chameleon  has  ribs  attached  to  the  two  lower  cervical 
vertebrae.  Croeodiles  also  have  cervical  ribs.  Snakes  have  ribs 
attached  to  all  vertebrae  except  those  in  the  tail.  The  greatest 
number  of  cervical  vertebrae  is  found  in  birds,  e.  g. :  the  sparrow 
has  9  and  the  swan  23. 

The  gorilla  and  chimpanzee  have  13  pairs  of  ribs.  The  theory 
of  a  certain  school  of  atavists  that  the  orang  utang  (the  man  of 
the  woods)  is  an  ancestor  of  man  finds  favor  in  the  fact  that  this 
animal  has  12  pairs. 

In  ]\rammalia  the  number  of  ribs  varies  from  9  pairs  in  *a 
species  of  whale  to  24  pairs  in  the  two  toed  sloth. 

Supernumerary  ribs  in  the  cervical  region  in  man  are  rather 
common,  Accurate  knowledge  of  their  occurrence  dates  back  to 
antiquity.  They  were  made  mention  of  by  Galen.  The  first 
operation  for  relief  of  symptoms  was  performed  in  1861  by  Coote. 
Murphy,  in  his  collection  from  the  literature  upon  the  subject, 
estimated  the  incidence  of  cervical  ribs  at  .03' >  and  that  from 
5'  (  to  10%  cause  symptoms. 

Fischel,  of  Prague,  in  examining  a  large  number  of  cadavers 
found  what  he  considered  some  sort  of  cervical  rib  in  1%  of  all 
cases.  This,  however,  seems  entirely  too  high  an  estimate.  Slight 
eloiigaiicn  of  the  transverse  process  of  the  Yth  cervical  vertebrae 
is  verv  common,  but  only  a  small  proportion  of  these  should  be 
ree;arded  as  abnormal. 


66 


Figure  I. 


67 


Figure  II. 


68 


69 

Pilling  in  1894  could  find  but  139  cases  reported.  Kadiographv 
lias  added  greatly  to  our  knowledge  concerning  the  subject  and 
has  proven  that  manv  well  developed  cervical  ribs  cause  no  trouble 
while  on  the  other  hand  serious  crippling  may  be  caused  by  small 
or  rudimentary  ribs. 

Development. 
In  man  cervical  ribs  are  due  to  variation  in  the  development  of 
the  vertebrae.  The  transverse  processes  of  the  6th  and  7th  and 
sometimes  the  5th  cen^ical  vertebra  contain  a  separate  center  of 
ossification  from  which  the  ventral  portion  of  the  process  is  de- 
veloped. This  is  known  as  the  costal  element  and  is  analagous 
to  the  ribs  in  the  thoracic  region  of  the  vertebral  column.  The 
over  development  of  this  element  varies  from  what  amounts  to  an 
elongation  of  the  process  (Fig-ure  I),  to  a  more  ot  less  complete 
rib  (Figure  III ).  The  transverse  processes  of  the  Tth  are  always 
more  prominent  than  those  of  the  other  cervical  vertebrae.  They 
have  normall}'  smaller  foramina  and  in  case  they  bear  supernum- 
erary ribs,  usually  have  no  formina  at  all.  Cer\dcal  ribs  may 
articulate  with  the  body  and  transverse  process  or  be  fused  with 
the  vertebra.  They  very  rarely  articulate  with  the  sternum,  the 
ventral  end  being  either  free  or  fused  with  the  first  throacic  rib 
or  its  cartilage  (Figiire  III).  The  rib  may  be  bifid  at  its  distal 
extremity.  This  condition  was  found  in  Case  II.  They  are  sel- 
dom symmetrical  when  well  developed,  though  cases  of  bilateral 
complete  ribs  have  been  reported.  Perrera^  reported  a  case  of 
l)ilateral  complete  cervical  ribs  in  which  the  artery  and  brachial 
plexus  passed  over  the  rib  on  the  left  side  and  under  the  rib  on 
the  right. side. 

Cei-vical  ribs  occur  bilaterally,  according  to  Pilling  and  Tilgh- 
man,  in  Q7%  of  cases  while  Miller^  found  them  to  be  bilateral  in 
80%.  Symptoms,  however,  are  nearly  always  unilateral,  and  ac- 
cording to  Streissler  are  more  common  on  the  left  side.  Symptoms 
of  cervical  ribs  occur  more  frequently  in  women  than  men ;  Streissr 
ler  Y0.87c  to  29.2%;  Church  60%  to  70%  in  women;  Keen 
75.6%. 

Age  Incidence, 
The  age  at  which  symptoms  appear  is  most  commonly  between 
puberty  and  30.     According  to  Streissler's^  table  the  incidence  is 
as  follows,  based  upon  a  study  of  143  cases : 

b-10     7.7% 

11-20  32.2 

21-30  30.0 

31-40  13.3 

41-50  11.2 

51-60     4.2 

61-70       .07 
Over  70       .07 


TO 

Etiology,  ■ 

Symptoms  generally  first  appear  after  a  trauma  such  as  falling 
upon  shoulder,  severe  blow  upon  the  side  of  the  neck  or  shoulder 
or  as  a  result  of  lifting  heavy  weight,  cranking  automobile,  carry- 
ing weight  upon  the  shoulder,  etc.  Posture  is  no  doubt  responsible 
in  some  cases.  The  first  symptoms  are  always  sensory.  These 
may  appear  immediately  following  an  injury  or  may  not  develop 
for  several  months  after  the  trauma,  as  in  Case  II. 

Todd^  produced  a  nerve  syndrome  upon  himself  similar  to  pres- 
sure from  ribs  by  sleeping  with  his  arms  extended  vertically 
above  his  head.  Church^  admonishes  that  every  case  presenting 
sensory  nei-ve  disturbance  of  the  upper  extremity  with  trophic 
changes  with  or  without  vascular  changes  should  be  examined 
for  cerviciu  ribs.  The  variations  in  the  syndrome  are  not  always 
in  accord  with  the  variations  in  the  size  of  the  ribs.  The  three 
cases  herein  reported  illustrate  fairly  accurately  the  symp corns  in 
the  stages  which  might  develop  in  a  single  long  standing  case.  In 
grading  the  development  of  the  cervical  rib  syndrome  it  is  better 
to  bear  in  mind  the  symptoms  rather  than  attempt  to  type  the 
case  according  to  the  shape  or  size  of  the  rib.  Small  rudimentary 
growths  may  cause  serious  symptoms  while  more  or  less  well  de- 
veloped ribs  may  be  attended  by  but  slight  disturbance.  The 
changes  in  the  nerves  and  vessels  being  due  to  pressure,  the  rela- 
tion of  the  supernumerary  rib  to  these  structures  and  not  the  size 
of  the  rib  is  the  determining  factor  in  producing  nervous  or  vascu- 
lar lesions. 

Local  Symptoms^ — Broadening  of  the  base  of  the  neck,  tumor, 
due  to  the  rib  or  an  aneurism  distal  to  the  stricture  in  the  artery, 
pain  on  pressure  over  cervical  nerves,  pulsation,  in  some  cases 
bruit  in  subclavian  artery.  Halstead^  reviewed  716  cases  and  found 
aneurism  or  some  degree  of  dilatation  of  the  subclavian  artery  in 
27.  Experimentally  he  always  found  the  dilatation  distal  to  the 
point  of  constriction.  He  also  noted  that  no  dilatation  occurred  in 
complete  closure  of  the  vessel  nor  did  he  find  any  enlargement  in 
vessels  with  only  slight  stricture. 

Nervous  Symptoms — These  vary  from  tingling  in  the  fingers 
to  marked  anaesthesia  and  paraesthesias  accompanied  by  severe 
pain  and  motor  disturbance  varying  from  muscular  weakness  to 
palsy  and  general  muscular  atrophy.  Pain  in  the  side  of  the 
head  about  the  external  ear  is  commonly  complained  of.  Glazing 
of  the  skin  and  brittleness  of  the  nails  occur  in  advanced  cases. 

Vascular  symptoms  are  not  nearly  so  frequent.  The  subclavian 
vein  is  very  seldom  involved.  A  few  cases  of  moist  gangrene,  due 
to  blocking  of  the  return  circulation  have  been  recorded.  In  cases 
where  the  arterial  circulation  is  interferred  with  the  subclavian  is 


71 

iisiiallj^  placed  high  in  the  neck  and  pulsation  in  this  vessel  can 
he  distinctly  observed.  In  case  the  artery  is  constricted  a  well 
marked  ischaemia  develops  in  the  whole  upper  extremity.  The 
skin  is  cold  and  pallid.  In  complete  constriction  or  thombosis  of 
the  vessel  the  entire  extremity  is  pulseless,  as  in  Case  III. 

Muscular  Symptoms — These  include  rapid  fatigue,  varying 
degrees  of  weakness  and  atrophy.  The  degree  of  atrophy  depends 
upon  the  severity  of  the  nerve  lesions. 

Differential  Diagnosis — Among  other  conditions  which  may  pro- 
duce symptoms  similar  to-  those  caused  by  cervical  ribs  may  be 
mentioned  fractured  first  thoracic  rib  with  excessive  callus  forma- 
tion, tumor  in  subclavian  triangle,  enlarged  lymph  nodes,  cervical 
scoliosis  with  compression  of  cervical  nerves,  apical  tuberculosis, 
subclavian  aneurism  and  enlarged  thyroid  gland. 

Treatment. 

The  treatmeitt  is  almost  entirely  surgical.  Medical,  electrical 
and  hygienic  treatment  is  only  useful  in  cases  where  the  deformity 
is  associated  with  tuberculosis,  syphilis- or  other  concurrent  disease. 
The  surgical  treatment  may  be  divided  into  mechanical  and  opera- 
tive. Many  patients  suffering  from  rudimentary  ribs  find  that  by 
elevating  the  arm  or  shoulder  the  pain  from  nerve  pressure  can  be 
lessened  or  relieved.  Others  develop  a  lateral  curvature  from 
habitual  abduction  of  the  neck.  Mild  cases  and  early  cases  may 
be  relieved  by  appliances  which  relieve  the  nerve  pressure  and 
immobilizes  the  cervical  spine.  The  treatment  described  in  Case 
I  is  both  simple  and  effective.  All  cases,  however,  without  taking 
into  consideration  the  size  or  shape  of  the  supernumerary  rib, 
which  prove  by  their  history  to  be  progressive  should  be  operated 
on  and  the  entire  rib  resected. 

Opeeation. 

The  rib  can  be  approached  from  behind  or  through  a  ventral 
incision.  The  ventral  approach  is  preferable  because  it  renders 
the  parts  involved  more  accessible  and  makesi  it  possible  to  always 
remove  the  entire  rib.  The  skin  incision  should  be  ample.  An 
incision  parallel  to  the  clavicle,  extending  from  over  the  lateral 
border  of  thei  trapezius  muscle  to  near  the  midline  of  the  neck  in 
front,  if  necessary  to  gain  the  exposure  desired,  is  the  one  of 
choice.  The  resulting  scar  is  less  conspicuous  than  when  a  vertical 
skin  incision  is  used.  After  dissecting  the  skin  and  fascia  well 
upward  a  vertical  incision  is  made  through  the  subcutaneous  tis- 
sues parallel  to  the  lateral  border  of  the  stemo  mastoid  muscle 
and  the  rib  and  nerve  trunks  exposed.    In  Case  III  a  second  inci- 


n 

sion  along  the  medial  border  of  the  sterno  mastoid  muscle  aided 
greatly  in  removing  the  ventral  extremity  of  the  rib.  All  superficial 
nerves  should  be  carefully  protected  from  injury.  The  suprascapu- 
lar nerve  and  transverse  cervieis  vessels  are  particularly  in  the 
way.  This  nerve  supplies  most  of  the  dorsal  scapular  muscles  and 
if  severed  causes  a  certain  amount  of  impairment  of  the  shoulder 
movements.  The  nerve  trunks  should  be  retracted  ventrally  and 
medially  until  the  dorsal  attachment  of  the  rib  can  be  reached. 
All  muscle  and  fibrous  tissue  attached  to  the  rib  should  l>e  sepa- 
rated. The  periosteum  should  be  left  intact  to  be  removed  with 
the  rib  in  order  to  prevent  bony  reformation.  The  entire  rib 
should  then  be  rongeured  away.  In  spite  of  the  most  careful 
handling  of  the  nerves  more  or  less  traumatic  neuritis  may  follow 
the  operation,  biit  unless  the  function  of  the  nerves  has  already 
been  destroyed  by  the  pressure  upon  the  rib,  perfect  function  will 
in  time  be  restored.  Opening  the  apex  of  the  pleural  cavity  is  an 
accident  which  should  be  carefully  avoided. 

aSTothing  can  be  done  as  a  rule  to  restore  the  circulation  in  the 
■subclavian  vessels  in  case  the  walls  have  been  damaged  by  pressure. 
In  case  of  complete  occlu5.ion  by  stricture  or  thrombosis  of  the 
artery  the  collateral  circulation  is  usually  adequate  to  preserve  the 
vitality  of  the  arm.  See  Case  III.  Complete  obstruction  of  the 
subclavian  vein  is  fortunately  very  rare,  but  in  the  few  cases  of 
this  kind  reported  gangrene  of  some  part  of  the  upper  extremity 
has  resulted. 

The  case  records  of  the  three  cases  here  appended  demonstrate 
fairly  well  three  types  of  syndromes  and  the  results  which  may  be 
expected  from  treatment. 

Case  I.  S.  W,,  widow,  aged  33.  Entered  hospital  July  3rd, 
1010,  complaining  of  pain  in  left  aide  of  her  neck  and  head  and 
upper  extremities.  Husband  died  three  years  ago.  Has  no  chil- 
dren. Family  history  negative.  Has  always  enjoyed  good  health. 
Was  married  at  eighteen ;  one  miscarriage  of  three  months.  She 
was  operated  on  for  appendicitis  1905.  In  1906  both  tubes  and 
ovaries  were  removed.  Suffered  rheumatism  six  years  ago.  Hem- 
orrhoidectomy eighteen  months  ago.  Four  years  ago  she  was 
thrown  from  a  wagon,  and  suffered  injury  to  left  side  of  neck,  left 
shoulder  and  left  hip.  Since  the  accident,  has  suffered  pain  con- 
tinuously in  left  shoulder,  left  side  of  neck  and  face,  and  a  numb 
sensation  in  both  upper  extremities.  Pain  is  worse  at  night.  The 
patient  suffers  a  great  deal  from  ner\^ousness  and  seems  depressed 
and  apprehensive  about  her  condition. 

Examination  on  Entrance. — Well  developed,  muscular  woman, 
healthy  in  appearance.  Teeth  are  suggestive  of  alveolar  disease. 
There  is  a  slight  discharge  from  the  left  ear.     There  is  a  slight 


7y 

hvperasthesia  in  left  side  of  neck  and  in  both  upper  extremities. 
Xo  muscular  atrophy  ot  weakness.  Joints  normal.  Movement* 
of  spine  normal  in  all  directions.  Left  sternoclavicular  joint  notice- 
iibly  enlarged.  Patient  claims  that  this  joint  was  injured  at  the 
time  of  accident  four  years  ago.  Blood  pressure:  left,  102-70; 
right,  105-70.  Examination  of  left  ear  by  Dr.  Tarun  demon- 
st]-ates  eczema  of  external  auditory  canal.  Drum  head  normal. 
X-ray  examination  of  neck  shows  bilateral  rudimentar\'  cervical 
rib.     See  Figure  I. 

Impression. — Sensory  disturbance  of  the  upper  extremities, 
neck  and  head  due  to  nerve  irritation,  probably  from  the  cervical 
ribs. 

The  patient  was  treated  for  ten  days  in  the  hospital  with  exten- 
sion applied  to  the  head  with  the  body  in  dorsal  decubitus  on  an  in- 
clined plane.  On  returning  to  her  home,  she  was  supplied  v»dth 
the  apparatus  for  a  continuance  of  the  same  treatment,  Avith  tulvice 
to  sleep  on  an  unyielding  bed  with  the  extension  apparatus  in 
operation. 

The  patient  reported  several  months  after  discharge  from 
the  hospital  that  the  pain  in  her  upper  extremities  and  neck  had 
very  much  diminished.  In  a  later  communication  she  stated  that 
she  was  suffering  no  trouble  with  her  spine  or  upper  extremities. 

Case  II.  X.  D.,  white  female,  single,  aged  24.  This  young 
woman  was  raised  on  a  farm  and  was  use  to  active  outdoor  life, 
frequently  engaging  in  the  labor  of  a  field  hand. 

Entered  University  Hospital  April  14,  1920,  suffering  pain  in 
right  upper  extremity  and  right  side  of  head  and  neck,  muscular 
weakness  in  forearm  and  shoulder  and  local  sensory  disturbances 
in  upper  extremity.  Parents  lining  and  in  good  health.  Four 
brothers  living.  Two  sisters  and  one  brother  died  in  infancy.  At 
the  age  of  16.,  patient  was  thrown  from  a  buggy,  injuiing  the 
right  shoulder.  Injury  caused  a  disability  of  two  months.  Sev- 
eral months  after  the  accident,  the  weakness  in  right  upper  ex- 
tremity was  noticed,  especially  in  muscles  of  forearm.  The  ex- 
tremity became  easily  fatigued  and  ached.  The  symptoms  became 
continuous,  but  apparently  did  not  become  more  marked  until  1918, 
when  she  suffered  an  attack  of  influenza  following  which  the  pain 
and  muscular  weakness  in  right  upper  extremity  steadily  increased. 
Pain  in  right  side  of  neck  and  right  side  of  head  also  increased 
and  became  constant  with  frequent  exacerbations  which  prevented 
rest  and  affected  her  nervous  system.  During  this  period  she  no- 
ticed changes  in  her  vision  and  discomfort  in  lioth  eyes.  On  en- 
tering the  hospital  the  pain  in  side  of  head,  especially  about  the 
external  ear  extending  down  the  neck  throughout  the  entire  upper 
extremity,  was  sufficiently  severe  to  cause  loss  of  sleep  and  seri- 
ously affect  the  general  tone  of  the  patient.     Pain  is  constant  but 


.74 

is  subject  to  exacerbations,  especially  in  the  head  and  neck  and 
shoulder. 

Physical  Examination. — Patient  is  well  developed,  short  of 
stature  and  except  a  slight  pallor,  tolerably  healthy  in  appear- 
ance. Examination  of  chest  negative.  Abdomen  negative.  There 
is  a  slight  asymmetry  in  the  neck,  right  side  being  apparently 
fuller  than  the  left.  There  is  a  slight  depression  over  the  supra 
spinus  and  infraspinous  fossae.  Deltoids  symmetrical.  Xo  atro- 
phy of  the  muscles  of  arm  and  forearm.  Marked  muscular  weak- 
ness throughout  the  entire  extremity,  including  both  flexors  and 
extensors.  Movements  of  extremity  cause  pain  and  sense  of  fatigue. 
Spine  negative.  There  is  an  area  of  tenderness  over  the  right 
posterior  triangle  of  the  neck,  especially  marked  at  the  ventral 
edge  of  the  trapezius  muscle.  At  this  point  a  hard  mass  can  be 
felt  on  deep  pressure.  Mass  is  immovable.  Left  upper  extremity 
normal.  ISTo  symptoms  of  motor  or  sensory  disturbance.  Neuro- 
logical examination  by  Dr.  George  M,  Settle.  ''Examination  re- 
veals general  weakness  in  the  flexors  and  extensors  of  right  hand, 
forearai  and  arm.  There  is  also  weakness  in  abduction  and  adduc- 
tion. There  is  a  slight  atrophy  of  right  supra  spinatus  muscle  and 
some  flatness  of  right  pectorals  and  right  triceps.  Eeflexes  are 
normal  on  both  sides.  Sensation  is  normal  in  right  upper  extrem- 
ity, except  on  dorsal  and  palmar  surfaces  of  the  hand  and  on 
flexor  surface  of  forearm,  in  which  areas  there  is  hyperesthesia. 
Pain,  temperature  and  muscle  sense  normal." 

Examination  of  urine  and  blood  negative.  Diagnosis:  Irrita- 
tive brachial  neuritis,  caused  by  cervical  rib.     See  Eigure  II. 

Operation,  April  16,  1920.  A  transverse  incision  was  made 
parallel  mth  the  clavicle  extending  from  the  dorsal  edge  of  the 
sternocleidomastoid  to  2  inches  beyond  the  ventral  border  of  the 
trapezius  muscle.  Skin  and  platysma  were  dissected  upward.  A 
vertical  incision  was  then  made  along  the  ventral  margin  of  the 
trapezius  for  about  3  inches.  This  incision  was  found  to  be  imme- 
diately over  the  cer\ncal  rib.  The  brachial  nerves  and  subcla^^an 
artery  were  gently  retracted  medially.  Bands  of  muscle  were  found 
to  be  attached  to  the  rib,  which  was  fixed  to  the  transverse  process 
of  the  7th  cervical  vertebra.  The  rib  extended  about  1  inch  beyond 
the  tip  of  the  transverse  process,  which  was  somewhat  longer  than 
usual.  The  lateral  extremity  of  the  rib  was  bifurcated  and  its 
superior  surface  contained  a  shallow  groove.  The  middle  trunk 
of  the  brachial  plexus  was  found  lying  in  the  gToove  and  passed 
through  the  notch  at  the  end  of  the  rib.  After  carefully  freeing 
muscular  attachments,  the  nerve  trunk  could  be  lifted  out  of  the 
notch  and  groove.  The  liberation  of  the  nerve,  however,  required 
considerable  effort,  which  probably  produced  undue  stretching  of 
the  nerve  fibres.     After  liberation  of  the  nerve  the  rudimentary 


Y5 

rib  and  part  of  the  transverse  process  were  rongeured  away.  The 
removal  of  the  rib,  it  was  found,  freed  the  nerve  trunk  from  pres- 
sure and  allowed  it  to  drop  into  its  normal  position.  A  cigarette 
drain  was  introduced .  into  the  wound  to  the  stump  of  the  trans- 
verse process  and  the  wound  closed.  The  right  upper  extremity 
was  immobilized  over  the  chest  with  the  right  hand  on  left  shoulder 
and  the  arm  in  extreme  adduction.  The  pleural  cavity  was  not 
opened.  The  greatest  difficulty  encountered  was  in  avoiding  the 
supra  scapula  nenT.  Subsequent  symptoms  indicated  injury  to 
this  nerve. 

Following  the  operation,  the  patient  complained  of  numbness  in 
the  right  hand.  There  was  slight  anaesthesia  throughout  the 
entire  upper  extremity.  The  wound  healed  per  primam,  but  a 
brachial  neuritis  developed  in  a  few  days,  evidently  traumatic  in 
origin,  as  a  result  of  the  handling  of  the  nerves  at  the  operation. 
There  was  also  some  atrophy  of  the  posterior  scapular  muscles. 
The  patient  was  referred  to  Dr.  Settle  for  treatment  of  the  neu- 
ritis which  coinpletely  cleared  up  after  several  months  treat- 
ment. Examination  in  February,  1921,  showed  complete  re- 
covery of  muscle  strength.  Patient  suffers  no  sensory  disturb- 
ances, except  occasionally  in  damp  weather  when  she  has  a  slight 
aching  in  the  side  of  her  head.  Posterior  scapula  muscles  have 
apparently  entirely  recovered.  ISTerve  and  muscular  condition  of 
upper  extremity  pronounced  by  "Dr.  Settle  at  this  time  to  be  nor- 
mal. X-ray  examination  of  stump  of  cervical  rib  and  transverse 
process  March  4,  1921,  shows  no  regeneration  of  the  bone. 

Case  III.  L.  E.,  white  female,  aged  48,  widow.  Entered  hos- 
pital j^Tovember  5,  1918,  complaining  of  paroxysms  of  pain  in 
right  upper  extremity  with  marked  weakness  and  atrophy  of  the 
muscles.  Patient  is  a  frail,  delicate  looking  woman,  apparently 
older  than  her  real  age.  There  is  no  history  of  any  disease  or 
injury  which  might  account  for  the  condition  of  her  right  upper 
extremity.  She  had  noticed  weakness  and  atrophy  of  the  muscles 
and  pain  in  the  right  forearm  and  hand  for  several  years,  which 
she  attributed  to  rheumatism  and  nerve  trouble.  Frequently  the 
pain  was  so  severe  as  to  require  morphine  for  relief.  Examination 
of  right  upper  extremity  shows  muscular  weakness  and  atrophy 
but  no  loss  of  mobility  of  the  joints.  Movements  cause  pain,  espe- 
cially about  the  shoulder.  There  is  evidence  of  trophic  disturb- 
ance of  the  skin  which  appears  very  pale,  thin  and  shiny.  All  the 
muscles  of  the  extremity  are  greatly  atrophied,  especially  those  of 
the  hand.  There  is  marked  diminution  of  the  tactile  sense,  but 
hyperasthesia  to  heat  and  cold.  jSTo  pulsation  can  be  detected  any- 
where in  the  extremity.  The  axillary  artery  can  be  palpated  and 
feels  like  a  fibrous  cord  about  the  size  of  a  small  lead  pencil.  There 
is  no  pulsation.     The  skin  feels  cold.     Patient  can  barely  flex  the 


76 

p]b,ow.  ITaiid  grip  extrpmelv  feeble.  A  liard  mass  can  be  dis- 
tinctly felt  in  the  region  of  the"  7th  transverse  process  in  both 
sides  of  neck.     See  Fignre  III. 

Impression. — Bilateral  cervical  ribs,  thrombosisi  right  axillary 
arterv,  right  brachial  neuritis,  mnscnlar  atrophy  of  right  upper 
extremity. 

Operation,  November  7,  19 1«.  Transverse  incision  made  2 
inches  above  and  parallel  to  the  right  clavicle.  Skin  dissected  up- 
ward and  downward,  making  a  wide  opening.  Vertical  incisions 
tlirough  the  platysma  and  fascia,  both  lateral  and  medial  to  the. 
sterno-mastoid  muscle  were  then  made.  This  made  approacJi  to 
the  cervical  rib  comparatively  easy.  Great  caution  was  used  in 
handling  the  brachial  nerves  to  prevent  trauma.  The  ril)  was 
found  to  be  articulated  with  the  7th  cervical  vertebra  dorsally, 
and  extended  to  the  costal  cartilage  of  the  first  rib  with  which 
it  was  fused.  It  was  found  necessary  to  expose  the  entire  rib. 
The  pressure  upon  the  subclavian  artery  and  brachial  nerves 
which  lay  on  top  was  caused  by  the  ventral  extremity  of  the  rib. 
The  entire  ril>  was  removed  with  a  rib  cutter  and  rongeur  forceps. 
The  wound  was  closed  and  a  cigarette  drain  introduced  as  far  as 
the  stump  of  the  rib.  The  pleural  cavity  was  not  opened  al- 
though the  pleura  was  found  attached  to  the  cervical  rib.  The 
right  arm  was  fixed  to  the  chest  in  adduction.  Wound  healed  per 
primam.  Patient  made  an  uneventful  operative  recovery.  She 
was  discharged  from  the  hospital  ]^ovember  21,  1918.  She  suf- 
fered no  paroxysms  of  acute  pain  after  the  operation.  Except 
for  a  transient  aggTavation  of  the  weakness  of  the  muscles  of  the 
upper  extremity,  no  trouble  resulted  from  the  operation.  On 
leaving  the  hospital  there  was  a  noticeable  increase  in  the  strength 
of  the  muscles  and  less  sense  of  coldness. 

January  10,  1919,  her  family  physician.  Dr.  O.  Fisher,  of 
Rockingham,  Virginia,  reported  that  the  arm  was  still  improving 
and  that  she  had  good  sensation  in  the  fingers  and  no  pain,  except 
when  the  hand  was  exposed  to  cold.  That  the  muscles  were  filling 
out  and  gaining  streng-th  continuously.  Patient  could  at  that  time 
pick  up  a  pin.  Color  of  skin  had  returned  to  normal.  Finger 
nails  appeared  normal.     There  was  no  pulsation  in  radial  artery. 

In  a  letter  from  the  patient  in  November,  1919,  she  stated  that 
she  could  move  her  arm  in  all  directions,  and  that  her  little  finger 
felt  "numb"  but  could  be  moved.  Muscular  strength  had  improved 
greatly  1)ut  the  arm  "tired  easily." 

In  a  letter  from  the  patient  March  15,  1921,  she  stated  that  the. 
letter  was  written  ^\nth  the  right  hand.     She  stated  that  she  was 
able  to  do  ordinary  housework  with  the  right  hand,  such  as  peel 
apples  and  sew.    In  fact  her  right  hand  was  as  strong  as  the  left, 
and  that  her  two  hands  were  the  same  size  and  the  same  color. 


77 

The  only  cliffeTeiice  in  the  two  hands  which  she  noticed  v/as  that 
the  right  was  more  sensitive  to  cold  and  there  was  still  some 
"numbness"  in  ring  and  little  fingers.  She  had  been  free  from 
pain  since  the  operation..  She  said  that  she  thought  the  right 
shoulder  was  a  little  lower  than  the  left  shoiilder  but  was  the  same 
size. 

BIBLIOGRAPHY. 

iPerrera, — Projr.  de  los  Clin.  l!tl!».  VII.  40. 

-^Miller,— J.  A.  M.  Sc.  1011,  143,  Nil. 

•■■Streissler. — Die  HaLsripijeii.  Ergelm.  il.  Cliir.  ii.  ortli  ."i.  JSO.  1013. 

-•Todd.— An.  Surg.  Jan.  1022.  p.  10.j. 

sChurch,— J.  A.  M.  A.  July  .-.  1010. 

'— Hal.stead.— Jour.  Exi».  Med.  lOllJ. 

NEPHEOLITHIASIS. 
By  ^Y.  Houston  Toulsox,  M.  D. 

In  analyzing  the  cases  of  kidney  stones  that  have  been  admitted 
to  the  University  Hospital  during  the  last  five  years,  certain  in- 
teresting observations  arc  noticed  that  may  be  worth  recounting. 

Out  of  a  total  of  22,000  cases  admitted,  fifty,  or  .27c,  were 
diagnosed  nephrolithiasis.  Of  these  fifty  cases,  sixteen  were  bi- 
lateral; 46%  showed  stone  in  the  right  kidney,  while  40 '/f  had 
stones  in  the  left  kidney.  Five  of  the  fifty  cases  showed  multiple 
stone  formation. 

In  this  connection,  it  isi  interesting  to  compare  these  statistics 
with  those  of  Braash,  who  reports  sixty-two  cases  of  bilateral 
stones  in  a  series  of  five  hundred  and  sixty-six  operations  for  cal- 
culus of  the  kidney;  and  those  of  Israel,  who  reports  sixty-four 
cases  in  five  hundred  and  seventy-two  operations. 

All.  of  our  cases,  but  one,  had  stones  of  inorganic  origin ;  they 
were  composed  of  urates,  phosphates  and  oxalates  and  varied  in 
size  from  that  of  a  small  pea  to  one  four  cm.  in  length,  the 
larger  size  stones,  without  exception,  were  found  in  the  pelvis 
of  the  kidney  rather  than  in  the  cortex.  The  one  exception  men- 
tioned was  a  case  of  bilateral  multiple  nephrolithiasis,  in  which 
the  stones  were  composed  of  cystin,  these  stones  were  about  the 
size  of  a  large  walnut  and  had  a  yellowisili,  translucent  appear- 
ence.  While  stones  of  organic  origin  are  rare,  cystin  stones  have 
been  found  to  be  the  most  common  of  the  rare  forms. 

Of  this  series,  64 Vr  were  white  males  and  06%  white  females; 
which  about  coincides  with  other  statistics.  In  spite  of  the  fact 
that  there  are  two  wards  for  colored  people  at  the  hospital  and 
the  fact  that  a  large  proportion  of  the  patients  in  the  dispensary 
of  the  hospital  are  colored,  not  one  case  of  renal  lithiaais  has 
been  operated  or  diagnosed  in  the  hospital. 


78 

The  ages  of  the  cases  in  this  series  range  from  18  to  59  years; 
the  average  being  38  years.  This  fact  is  also  noted  by  Ransohoff, 
who  states  that  the  disease  is  one  of  the  third  decade  of  life. 

The  symptoms  are  noteworthy  and  vary  considerably  with  the 
location,  size,  shape  and  duration  of  the  stone.  In  practically 
all  of  these  cases  pain  was  the  outstanding  symptom.-  The  pain 
was  most  interesting  and  occurred  commonly  as  a  definite  pa- 
roxysm and  was  attended  by  chills,  fevers,  and  sweats.  The  pain 
usually  began  in  the  region  of  the  kidney  and  radiated  chiefly 
along  the  course  of  the  urinary  tract  on  the  affected  side,  it  was 
strikingly  present  at  the  end  of  the  urethra.  Some  of  these  pa- 
tients, however,  complained  of  pain  in  the  lower  abdomen,  which 
was  more  pronounced  than  the  pain  in  the  kidney  region,  so  that, 
in  many  instances  mistaken  diagnoses  resulted.  The  most  common 
source  of  error  was  the  diagnosis  of  appendicitis ;  three  cases  of 
the  present  series  were  opeorated  on  previously  for  appendicitis. 
Braash  reports  one  case  in  his  series,  that  complained  of  gastric 
symptoms  and  was  operated  on  for  duodenal  ulcer,  while  several 
writers  have  reported  salpingitis,  oophoritis  and  adhesion?  as  mis- 
taken diagnoses. 

In  most  of  these  cases,  QO^  i ,  there  was  pain  associated  with 
typical  colicky  attacks,  yet  there  were  two  instances  where  the 
patients  were  devoid  of  pain,  their  presenting  symptom  being  fre- 
quency of  urination.  In  one  instance  pain  in  the  kidney  region 
was  felt  only  on  moving,  the  patient  being  perfectly  comfortable 
when  quiet.  Another  patient  had  marked  suprapubic  pain  as  the 
only  symptom.  In  three  cases  the  pain  was  referred  to  the  oppo- 
site side,  this  condition  is  described  as  the  ''reno-renal"  reflex, 
these  particular  cases  emphasizes  the  importance  of  examining  the 
entire  urinary  tract,  where  stone  is  suspected;  for,  if  we  limit  the 
observations  to  the  suspected,  or  symptom  side,  we  may  overlook 
the  causative  factor  in  the  other  side. 

Tenderness  could  usually  be  elicited  by  bi-manual  palpation 
over  the  affected  kidney ;  the  more  acute  the  symptoms,  the  more 
exquisite  was  the  soreness.  One  of  the  cases  of  bilateral  nephro- 
lithiasis complained  of  severe  backache  and  was  very  tender  across 
the  loins,  here  the  urinarv^  changes  lead  to  the  diagnosis. 

Frequency  of  urination  was  the  most  common  of  all  the  symp- 
toms, this  was  manifested  in  all  the  cases  at  some  period  during 
the  disease.  Xycturia  was  present  in  all  but  one  case;  diiirnal 
frequency  was  noticed  in  all.  The  frequency  was  more  marked 
at  the  time  of  the  attacks  of  kidney  colic,  dysuria  was  also  noted 
in  a  rather  high  percentage  of  the  cases.  Blood,  either  macro- 
scopic or  microscopic,  appeared  in  all  the  cases,  albumin  was  found 
in  the  urine  in  70%  of  the  cases,  and  pus  cells  coukl  ]w  demon- 
strated in  60%. 


79 

In  only  one  case  was  there  urethral  discharge  and  this  was  in 
termittent,  the  discharge  showed  microscopically  a  mixed  and  dif- 
fuse flora  of  bacteria. 

Practically  all  of  the  observed  cases  had  fever  ranging  from 
99°  to  100°  F.  This  fever  occurred  in  the  evening  and  subsided 
in  the  morning  to  normal,  it  seemed  to  bear  no  relation  to  the  ap- 
pearance of  pus  in  the  urine,  for,  in  several  instances  with  con- 
stant evening  elevations  of  temperature,  the  repeated  urinalyses 
showed  no  pus  cells. 

Of  all  the  subjective  symptoms,  pain  is  the  most  important  aid 
to  diagnosis,  this  characteristic  symptom,  especially  when  attended 
by  disturbed  urinary  function,  should  lead  to  a  suspicion  of  stone 
in  the  kidney. 

The  X-ray  will  usually  aid  materially  in  the  diagnosis,  but 
even  this  ag:ent  is  fallible,  for  at  least  three  per  cent  of  stones 
fail  to  show  in  the  radiograph,  uric  acid  stones  are  particularly 
hard  to  reveal  in  the  shadow,  again,  there  is  often  a  confusion 
between  phleboliths  and  regional  calcareous  glands.  It  is  most 
important  that  patients  to  be  radiographed  be  properly  prepared 
i.  e.,  the  intestines  should  be  as  free  from  gas  as  possible. 

Cystoscopy  is  necessary  to  establish  the  presence  or  absence  of 
stone  in  the  bladder.  Ureteral  catheterization  will  give  an  indi- 
cation of  the  condition  of  the  urine  from  the  kidneys,  and,  with 
the  help  of  the  shadow-throwing  catheter,  prevent  confusion  be- 
tween the  diagnosis  of  renal  calculi  and  phleboliths  and  calcareous 
glands.  The  ureteral  catheterization  with  the  functional  tests 
will  give  an  indication  of  the  condition  of  the  kidneys,  which  is 
most  necessary  in  case  of  operation.  Pyelography  sheds  much 
light  on  the  location  of  the  stone  in  the  kidney  and  frequently 
points  out  to  the  surgeon  whether  the  stone  can  be  reached  through 
the  ]>elvis  of  the  kidney  or  whether  it  be  lodged  in  the  cortex, 
when  nephi'otomy  must  be  done. 

In  some  of  these  eases  there  was  increased  phthalein  output 
on  the  damaged  side,  this  may  be  explained  by  increased  vas- 
cularity, which  may  be  due,  either  to  infection  or  irritation,  or 
both,  caused  by  the  offending  stone.  Occasionally  no  diminution 
of  phthalein  output  was  seen,  even  where  the  kidney  substance  had 
been  materially  destroyed.  This  observation  has  been  described 
in  many  other  diseases  of  the  kidney. 

The  retained  nitrogen  in  the  blood,  which,  by  some  authorities 
is  regarded  as  the  best  index  to  the  kidney  function,  was  not  done 
in  all  cases,  because  the  first  of  these  cases  were  admitted  four 
or  five  years  ago  when  the  use  of  the  blood  ehemistrv'  was  not  so 
common,  in  those  cases  the  phthalein  test  was  compared  with  the 
amount  of  urea  in  the  urine.     Recently,  however,  the  blood  nitro- 


80 

gen  has  been  checked  up  with  the  phthalein  test  and  in  most  in- 
stances the  blood  nitrogen  was  fonnd  to  be  normal. 

The  leiicocytosis  varied  with  the  fever,  it  ranged  from  10,000 
to  22,000,  averaging  abont  14,000;  the  polymorphonuclear  cells 
predominating  in  the  differential  count. 

SiTj\r]\rARY. 

A  careful  history  is  essential  in  these  caseS',  for  example,  a 
diurnal  frequency  of  urination  may  be  physiologic,  but,  when 
combined  with  a  nocturnal  frequency  ordinarily  points  to  some 
pathologic  process  of  the  urogenital  tract. 

The  character  of  the  pain  is  in  itself  often  diagnostic,  particu- 
larly in  its  relation  to  the  function  of  micturition. 

The  appearance  of  blood  in  the  urine  is  of  extreme  importance 
and  should  never  be  neglected,  whether  bright  in  color  or  mixed 
with  urine  and  whether  it  occur  before,  during  or  after  urination, 
should  be  noted. 

Since  the  introduction  of  the  alkaline  halogen  solutions  pyel- 
ography has  been  made  a  much  safer  and  less  painful  procedure. 

In  every  case  of  pyelotomy  retrograde  catheterization  of  the 
ureter  shoidd  be  done  to  ascertain  the  presence  or  absence  of  any 
offending  substance. 

Stereoscopic  views  should  be  had  of  small  stones  in  the  kidney, 
difficult  of  localization. 

In  spite  of  precautions,  about  10' f  of  these  cases  recur.  Cabot 
has  advised,  as  a  preventive,  the  examination  of  the  urine  for 
concentration  of  inorganic  salts;  for  concentrations  of  urates  the 
administration  of  lithium  or  potasji  salts  is  recommended,  for, 
oxalates,  he  would  prohibit  the  use  of  fruits  containing  vegetable 
acids,  and  for  phosphates,  he  gives  nitro-hydrochloric  acid. 

After  operation  it  would  seem  advisable  to  turn  these  cases  over 
to  the  internist  for  metabolistic  studies. 


REPORT   OF   SOME   CASES   OF   INFECTION   OF   THE 

NASAL  ACCESSORY  SINUSES  PRESENTING 

UNFSTTAL  SYMPTOMS. 

Edward  A.  Loopee,  M.  D. 

^lany  cases  of  disease  of  the  nasal  accessary  sinusos  present  a 
well  defined  group  of  clinical  symptoms  which  make  the  diagnosis 
and  treatment  comparatively  easy.  It  is  the  borderline  cases 
which  give  us  most  concern.  The  cases  in  which  the  nasal  s^onp- 
toms  are  insignificant  or  are  masked  by  certain  general  symptoms 
of  toxic  absorption  so  that  the  attoution  is  directed  along  other 
lines.      This   is  especially  true  of  cases  which  produce   arthritis 


81 

and  indefinite  rheumatic  pains,  digestive  disturbances,  malaise, 
headache  and  vertigO'. 

Considering  the  anatomical  structure  and  close  relationship  of 
the  sinuses  to  other  important  structures,  it  is  not  uncommon  that 
the  most  prominent  symptoms  co^me  from  these  special  organs. 
The  most  typical  example  is  found  in  eye  lesions,  cranial  involve- 
ment and  reflex  nervous  phenomena. 

The  following  cases  represent  a  few  illustrations  of  types  in 
which  the  nasal  symptoms  were  somewhat  obscured  by  more  pro- 
nounced symptoms  of  involvement  in  other  structures. 

Mrs.  J.  G.,  age  35,_  was  sent  to  me  for  examination  as  to  tliie 
cause  of  extreme  vertigo,  which  was  especially  severe  when  lying 
down  and  on  turning  to  the  right  side.  Associated  with  the  vertigo 
was  constant  frontal  headache,  greater  over  the  right  eye,  but  was 
more  or  less  disseminated  over  the  right  side  of  the  head.  The 
patient  gave  a  history  of  having  similar  attacks,  but  milder  in 
form  for  intermittent  periods  during  the  past  fifteen  years.  Two 
months  before  she  was  sent  to  me  the  exacerbations  had  become  so 
constant  and  severe  that  she  wag  almost  a  nervous  wreck,  in  fact 
she  presented  a  typical  picture  of  neurasthenia.  She  could  not 
sleep,  was  very  apprehensive  and  there  was  a  peculiar  feeling  of 
weight  and  pulling  sensation  in  the  right  side  of  her  head.  Pain 
was  present  in  the  occipital  region  and  at  a  point  in  her  left 
shoulder.  Her  skin  was  sallow,  appetite  was  lost  and  she  was 
totally  incapacitated. 

ISTasal  examination  showed  slight  tenderness  under  right  frontal 
sinus.  There  was  a  high  posterior  deviation  of  the  septum  to  the 
right.  Breathing  space  was  limited  on  this  side.  Constant  post- 
nasal discharge.  Transillumination  showed  clouding  of  right 
frontal  sinus,  which  was  confinned  by  X-ray  examination. 

On  October  10,  1919,  a  conservative  operation  was  performed. 
The  deviated  septum  was  corrected  and  the  anterior  part  of  middle 
turbinate  resected.  For  about  two  weeks  there  was  decided  im- 
provement. The  attacks  of  vertigo  became  less  frequent  and  the 
pain  subsided.  There  was  a  profuse  nasal  discharge.  G-radually 
the  symptoms  became  worse  until  she  was  suffering  about  as  much 
as  ever,  so  it  was  decided  that  more  drainage  was  necessary. 

At  the  second  operation  a  more  complete  intranasal  operation 
was  performed.  The  ethmoid  cells  were  curetted  and  the  naso- 
frontal duct  enlarged.  As  before,  there  was  a  period  of  tempor- 
ary improvement,  but  eventually  there  was  a  recairrence  of  the 
most  prominent  symptoms:  so  that  the  patient  was  getting  very 
much  discouraged  and  depressed. 

Bv  this  time  it  seemed  to  me  that  a  radical  operation  would  be 
necessary  if  any  form  of  pennanent  relief  was  to  be  obtained. 


82 

On  June  12,  1921,  a  radical  operation  was  performed.  Wlien 
the  anterior  wall  of  the  frontal  sinus  was  opened  a  great  quantity 
of  creamy  pus  poured  out.  There  was  also  a  collection  of  granu- 
lation tissue  on  the  floor  of  the  sinus,  showing  the  result  of  a  long 
standing  infection. 

She  recovered  from  the  operation  without  complications  and  the 
cosmetic  result  was  surprisingly  good.  All  vertigo  and  headache 
rapidly  disappeared  and  her  nervous  condition  began  to  clear  up. 
In  a  short  time  all  symptoms  had  entirely  disappeared  and  she 
was  sent  home. 

About  one  month  ago  she  reported  to  my  oSice  and  told  me  that 
she  was  feeling  fine,  had  gained  several  pounds  in  weight,  skin 
was  clear  and  she  did  not  suffer  wdth  either  vertigo  or  headache. 
She  is  now  working  every  day  without  diflaculty. 

A  man  37  years  of  age  was  sent  to  Baltimore  from  Xorth  Caro- 
lina with  a  diagnosis  of  suspected  brain  tumor.  He  was  suffering 
with  intense  frontal  headaches,  limited  to  the  left  side  and  ex- 
tending to  the  occipital  region.  He  had  a  gi*eat  deal  of  vertigo 
and  nausea.  When  his  pain  and  headaches  were  most  severe, 
there  was  a  spasmodic  twitching  of  the  left  arm,  simulating  at- 
tacks of  Jacksonian  epilepsy.  He  had  photophobia  and  eyes  would 
tire  easily  after  reading.  There  was  a  history  of  repeated  colds 
and  obstruction  to  breathing  on  the  left  side.  A  general  and 
special  examination  for  intracranial  new  growths  proved  to  be 
negative. 

Examination  of  the  nose  revealed  tenderness  under  the  floor  of 
left  frontal  sinus.  The  septum  was  deviated  to  the  left.  Xo  nasal 
discharge.  The  left  middle  turbinate  was  very  much  hypertro- 
phied.  By  transillumination,  the  left  frontal  sinus  appeared 
darker  than  the  right.  X-ray  showed  a  small  left  frontal  sinus 
which  was  cloudy. 

At  the  time  of  operation  the  deviated  septum  was  corrected, 
hypertrophied  middle  turbinate  was  resected,  ethmoidal  cells  cu- 
retted and  nasal-frontal  duct  enlarged. 

After  a  week,  symptoms  began  to  improve,  all  vertigo  and 
nausea  disappeared.  Headache  and  pains  soon  cleared  up  and 
patient  was  sent  home  free  of  all  symptoms. 

Mrs.  J.  C.  L.,  age  84.  September  23,  1919.  Three  years  ago 
present  trouble  started  with  severe  pain  in  and  over  left  eye,  radi- 
ating to  temple,  back  of  head  and  neck.  The  pain  was  exaggerated 
by  exertion,  especially  on  climbing  sitairs,  stooping  over  or  any 
jarring  motion.  Headaches  were  practically  constant,  and  at  men- 
strual period  became  intense  and  unbearable,  so  that  morphia  was 
necessary  for  relief  in  each  instance.  After  about  four  months 
she  developed  severe  pains  in  left  hip  and  shoulder,  more  severe 


83 

in  the  morning,  lost  weight,  appetite  was  poor,  skin  sallow  and  she 
was  extremely  nervous. 

During  the  past  few  years  her  symptoms  were  so  distressing 
that  she  consulted  a  number  of  doctors  for  relief  and  during  the 
course  of  their  treatment  eight  surgical  operations  had  been  per- 
formed. Her  appendix  had  been  removed.  Gall  bladder  drained. 
An  operation  for  hemorrhoids.  A  dilatation  and  curretage.  Her 
eyes  were  examined  a  number  of  times,  but  no  nasal  condition  had 
been  suspected. 

With  all  of  the  above  operations,  no  relief  had  been  obtained. 
Her  headaches,  prostration  and  general  condition  became  worse. 
On  September  1,  1919,  patient  was  referred  to  me  for  examina- 
tion of  her  sinuses  as  a  possible  cause  of  the  trouble.  At  the  time 
of  the  examination  she  was  suffering  intense  pain  in  the  left  eye 
and  left  side  of  face,  extending  to  back  of  head  and  neck.  She 
complained  of  constant  postnasal  discharge  and  obstruction  to 
breathing  on  the  left  side.  At  this  time  her  physical  condition 
was  very  bad,  skin  sallow,  no  appetite,  was  weak  and  easily  pros- 
trated. She  was  very  nervous  and  could  not  sleep  well.  The  pain 
was  so  excruciating  that  morphia  was  generally  required  to  obtain 
relief.  Vertigo  was  a  constant  symptom  and  any  nasal  treatment 
was  followed  by  nausea. 

Examination  showed  slight  tenderness  under  left  frontal  sinus. 
'No  clouding  made  out  by  transillumination.  There  was  a  high 
posterior  deviation  of  septum  to  the  left  with  limitation  of  breath- 
ing space  on  this  side.  Sense  of  smell  obtunded.  Profuse  nasal 
discharge,  a  small  amount  in  middle  meatus. 

X-ray  examination  showed  clouding  of  left  sphenoids  and  ethe- 
moids.  For  a  time  local  astringent  applications  and  adrenalin 
tampons  afforded  so  much  relief  that  I  was  convinced  that  an 
operation  would  improve  the  condition. 

The  first  operation  was  a  conservative  one  under  local  anes- 
thesia. For  about  a  week  she  showed  signs  of  improvement,  but 
at  the  end  of  this  time  her  old  symptoms  recurred  so  that  she  was 
suffering  about  as  much  as  ever.  At  the  second  operation,  under 
general  anesthesia,  the  deviation  of  the  septum  was  corrected,  the 
ethmoid  cells  Completely  exenterated  and  sphenoids  drained.  Fol- 
lowing this  operation  there  was  gradual  improvement,  and  at  the 
end  of  three  weeks  all  headaches  and  disagreeable  symptoms  had 
disappeared. 

Since  the  operation  I  have  had  several  letters  from  her  express- 
ing appreciation  for  being  "made  over"  as  she  expressed  it,  and 
telling  me  that  she  has  had  no  headaches,  has  gained  several 
pounds  in  weight,  skin  is  clear  and  she  feels  fine. 

This  patient  could  have  been  saved  much  suffering  and  needless 
expense  if  a  careful  investigation  of  the  sinuses  had  been  made 
earlier. 


84 

Dr.  E.  H.  P.,  age  42,  was  refenred  for  examination  of  the  sin- 
uses as  a  possible  cause  of  the  following  toxic  symptoms : 

For  one  3'ear  the  patient  had  been  unable  to  pursue  his  usual 
avocation,  dentistr}-.  Much  of  the  time  he  had  been  in  bed.  His 
skin  was  sallow,  appetite  was  lost.  He  had  serious  digestive  dis- 
turbances, one  interesting  feature  of  which  was  obstinate  consti- 
pation and  a  heavy  gi'inding  sensation  which  would  appear  very 
late  every  afternoon.  He  had  no  energy,  was  extremely  nervous 
and  irritable  and  it  Avas  difficult  for  him  to  sleep. 

jSTasal  examination  showed  a  profuse  nasal  discharge  of  foul 
odor  which  was  most  marked  on  the  right  side.  There  was  an 
infection  of  both  antra  and  the  ethmoids.  The  ethmoids  and 
antra  were  curetted  and  drained,  after  which  there  was  gradual 
improvement. 

Today  the  patient  is  perfectly  well.  His  color  is  good,  appetite 
fine  and  all  digestive  disturbances  have  disappeared.  He  does 
hard  work  every  day  without  difficulty  and  has  had  no  recurrence 
of  his  symptoms. 

E.  G.,  age  25,  consulted  me  on  September  9,  1920,  for  sudden 
loss  of  vision  in  the  left  eye  which  had  developed  about  a  week 
previous  to  this  visit.  He  had  suffered  no  pain,  gave  no  history  of 
nasal  infection  or  discharge.  His  complaint  was,  that  he  arose 
one  morning  and  found  his  vision  very  much  blurred  in  the  left 
eye,  which  continued  to  get  worse  until  he  could  not  see  his  hand. 
Associated  with  this  was  marked  vertigo  and  slight  nausea. 

At  the  time  of  my  examination  his  left  pupil  was  about  1  mm. 
larger  than  the  right.  Muscular  movements  were  normal  in  all 
directions.  Vision  was  limited,  for  he  could  make  out  only  the 
tips  of  my  fingers  at  one  foot.  Visual  field,  as  shown  on  chart, 
was  concentrically  contracted  to  ten  degrees.  He  could  not  dis- 
tinguish colors.  Ophthalmoscopic  examination  showed  slight 
hyjieraemia  and  faint  blurring  of  the  edges  of  the  optic  disc. 
Fundus  otherwise  negative. 

The  extraocular  structures  of  the  right  eye  were  negative.  Pu- 
pillary reactions  good.  Ocular  movements  normal.  Vision  20/20. 
No  pathological  changes  made  out  in  fundus.    Visual  field  normal. 

Nasal  examination  showed  marked  clouding  of  left  antrum  by 
transillumination  and  confirmed  by  X-ray  examination.  There 
was  no  tenderness  over  the  sinuses.  No  nasal  discharge.  Breath- 
ing space  unobstructed.  In  fact,  if  transillumination  and  X-ray 
had  not  been  used,  there  would  ha^'e  been  no  findings  to  indicate 
sinus  involvement. 

On  September  11,  1920,  the  left  antrum  Avas  drained  and  a 
small  (])mntity  of  scro-purulent  discharge  evacuated.  The  follow- 
ing morning  when  ]  visited  him  in  the  hospital,  to  my  surprise  he 
exclaimed,  "1  can  see  ]M>rfectly  well,''  and  on  testing  his  \'ision  I 
fouud  that  he  could  read  fine  newspaper  print  without  difficulty. 
He  did  not  complain  of  headache  or  vertigo,  and  felt  fine. 


85 

The  next  day  on  taking  his  visual  tield  I  found  it  had  improved 
about  15°,  and  in  five  days  had  returned  to  normal  with  normal 
vision.  The  hyperaemia  of  the  optic  disc  had  also  disappeared 
and  there  was  no  vertigo. 

The  interesting  feature  of  this  case  was  the  sudden  loss  of 
vision. in  the  left  eye  with  no  history  of  nasal  infection. 

The  rapid  irecovery  of  visual  acuity  after  operation  would  un- 
doubtedly place  this  in  the  class  of  cases  of  mechanical  pressure 
on  the  optic  nerve  in  the  optic  canal. 

A  stud}'  of  the  above  cases  will  show  that  their  interesting  feat- 
ures lie  in  the  fact  that  the  most  important  manifestations  were 
produced  by  involvement  of  other  structures. 

In  several  cases  the  classical  nasal  symptoms  of  obstructed 
breathing,  disturbances  in  the  sense  of  smell,  chronic  discharge 
and  tenderness,  over  the  sinuses  were  entirely  absent,  or  were  so 
slight  that  the  patients  gave  no  subjective  symptoms  of  discomfort, 
so  that  attention  was  misdirected  to  the  secondary  structures. 

It  is  a  common  occurrence  to  find  an  infected  sinus,  which  pro- 
duces few  or  no  local  symptoms,  which  may  be  acting  as  an  active 
focus  of  infection  resulting  in  a  train  of  toxic  symptoms  affecting 
the  general  system. 

To  my  mind,  too  much  stress  has  been  given  to  local  nasal  symp- 
toms in  the  past,  while  the  general  manifestations  have  been  more 
or  less  neglected  and  their  importance  as  a  diagnostic  aid  has  not 
been  appreciated. 

For  this  reason,  a  careful  history  and  a  complete  physical  exam- 
ination will  often  reveal  an  unsuspected  symptom  which  would  be 
entirely  overlooked  if  we  depended  only  upon  the  local  nasal  symp- 
toms. Furthermore,  where  the  diagnostician  is  dealing  with  a 
case  presenting  symptoms  of  absorption,  it  would  seem  that  the 
reasonable  thing  to  do  would  be  to  begin  the  investigation  at  the 
nose  and  throat,  for  we  know  that  this  is  the  most  vulnerable  loca- 
tion for  foci  of  infection. 

Instead  of  this  procedure,  we  often  find  that  the  nose  and  throat 
are  the  last  to  be  investigated  and  are  frequently  not  even  con- 
sidered. 

Co^'CLUSIONS. 

]\Iany  cases  of  sinus  infection  show  few  or  no  local  symptoms, 
but  may  be  producing  severe  symptoms  in  other  structures. 

The  general  symptoms  are  most  important,  and  in  any  case  of 
chronic  absorption  from  some  focal  point  the  nasal  structures 
should  be  the  first  to  be  investigated. 

'Ro  thorough  medical  examination  should  be  considered  com- 
plete without  a  careful  nasal  examination. 

G05  Park  Avenue. 


86 

BOAED  OF  TRUSTEES  ENDOWMENT  FUND 
UNIVEESITY  OF  MARYLAND. 

Report  of  B.  Merrill  Hopkinsoi?,  M.  D.,  Treasubek. 

Covering  the  Period  January  10,  1921,  to  January  9,  1922. 

FACULTY  OF  PHYSIC  FUND. 

January  10,  1921,  balance  Central  Savings  Bank $1,085.07 

April  12,  1921,  interest  Central  Savings  Bank,  October- April 1.5.05 

October  1.  1921,  interest  Central  Savings  Bank.  April-October 14.68 

January  1.  1922,  interest  on  all  bonds  to  date 1.6.8.0.62 


Deduct :  $2,800.42 
Jan.   24,   1921,   adjustment  of   interest,   exchange   of 

Newburgh  L.  H.  &  P.  Co.  for  Central  Hudson  Gas 

&  Electric  Co $2.92 

March  9,  1921,  1  1,000  Penna.  R.  R.  61/2  Bonds 992.50 

March  9,  1921,  Accrued  Interest,  1  month,  9  days 7.04 

March  29,  1921.  Coupon  Minneapolis  G.  L.  Returned 25.00 

May  25,  1921,  Colonial  Trust  Co.  Box 5.00 

November  21,   1921,   Coupon   Grand  Trunk   Railway   to 

Hemmeter  Fund  35.00 

1,067.46 

January  1.  1922,  balance  Central  Savings  Bank $1,732  96 

This  Fund  consists  of: 

2  1,000  Am.  Agricul.  Chem.  Co.  0%  Bonds 1,963.06 

1      500  Central  Hudson  G.  &  E.  7%  Bond 500.00 

3  1,000  Central  Hudson  G.  &  E.  7%  Bonds 3.000.00 

1  1.000  Ga..  Car.  &  Northern  0%  Bond 1.000.00 

5      500  Regents  University  of  Maryland  5%  Bonds 2,500.00 

1  1,000  Public  Service  Corporation  of  New  Jer.sey  5%  Bond 1.000.00 

1  1,000  Minneapolis  G.  L.  5%  Bond 1,000.00 

1  1,000  Edison  Electric  Company  n%   Bond 1.000  00 

1  1.000  Fairmount  and  Clarksburg  Trac.  Co.  5%  Bond 1.000.0<1 

1  1.000  Consolidated  Gas.  Baltimore,  4l^%  Bond 980.00 

2  1,000  Omaha  &  Council  Bluffs  St.  Ry.  5%  Bonds 1940.00 

2  1,000  Cincinnati  Gas  &  Trans.  Co.  5%  Bonds 1.960.00 

2  1,000  W.  Penn.  Power  Co.  5%  Bonds 1.940.00 

2  1,000  Cumberland  Co.  P.  &  L.  5%  Bonds 1.940.00 

2  1.000  Louisiana  Port  Serial  Commission  5%  Bonds 2.00O.00 

1  LOOO  Grand  Trunk  of  Canada  ~%  Bond 1.0<:»0.00 

1  1.000  Pennsylvania  Railroad  QV^Vc  Bond 1.00<:».00 

1  1.000  Baltimore  County  5%%  Bond 1.000.00 

1  500  First  Liberty  Loan  3ii%  Bond .500.00 

3  1.000  Third  Liberty  Loan  41/2 9'f  Bonds 3.000.00 

2  1.000  Fourth  Liberty  Loan  Bonds 2.000.00 

1      .500  Fourth  Liberty  Loan  4'  L-7f   Bond .500.00 

$34,456.02 


87 

GENERAL  ENDOWMENT  FUND. 

January  10,  1921,  balance  Central  Savings  Bank $498.22 

April  1,  1921,  interest  Central  Savings  Bank,  October-April 8.57 

October  1,  1921,  interest  Central  Savings  Bank.  April-October...  14.38 

January  1,  1922,  interest  on  all  bonds  to  date 575.62 

$1,096.79 
Deduct : 

December  6.  1021.  Treasurer's  Bond,  Maryland  Casualty  Co 12.50 

January  1.  1922.  balance  Central  Savings  Bank $1,084.29 

This  Fund  consists  of: 

1      500  Regents  University  of  Maryland,  5%  Bond $500.00 

1  1.000  Georgia  and  Alabama  5%  Bond 1,000.00 

1  1.000  Georgia,  Carolina  and  Northern  5%  Bond 1,000.00 

1  1,000  Omaha  and  Council  Bluffs  R.  &  B  5%  Bond 1,000.00 

1  1,000  Consolidation  Coal  Company  6%  Bond 1,000.00 

2  500  Consolidation  Coal  Company  6%  Bonds 1,000.00 

2  1.000  St.  Jos.  Ry.  L.  H.  &  P.  Co.  5%  Bonds 2,000.00 

1  1,000  Edison  Elec  Co.  5%  Boud 1,000.00 

1  1.000  Baltimore  County  5%%  Bond 1,000.00 

1     500  First  Liberty  Loan  314 500.00 

1  1,000  Third  Liberty  Loan  4%%  Bond 1,000.00 

1      500  Fourth  Liberty  Loan  414%  Bond 500.00 


$12,584.29 


LEO  KARLINSKY  FUND. 

This  Fund  consists  of: 
3  1.000  Great  Northern  Ry  Co.  7%  Bonds $3,000.00 


DENTAL   FUND. 

January  10,  1921— Balance  Central  Savings  Bank $24.80 

April  1,  1921 — Interest  Central  Savings  Bank,  October-April .40 

November  21,  1921 — Interest  Central  Savings  Bank,  April-October  .50 

January  1.  1922 — Balance  Central  Savings  Bank $25.70 

HEMMETER  FUND. 

January  10.  1921— Balance  Central  Savings  Bank $77.20 

April  1,  1921 — Interest  Central  Savings  Bank,  October- April 1.58 

OctoBer  1,  1921 — Interest  Central  Savings  Bank,  April-October..  4.40 

January  1,  1922 — Interest  on  all  Bonds  to  date 305.00 

$388.18 


88 

This  Fund  consists  of: 

L  1,()0(>  Chicago  City  Railway  Bond  5% '    1.00(1.00 

I  1.000  Chicago  Railways  Bond  5% 1.<MI0.00 

1  1,000  Minneapolis  St.  Ry.  &  St.  Paul  Ry.  Bond  5% 1.0<i<i.00 

2  1,000  Third  Liberty  Loan  414% 2.0(Mt.0<» 

1  1,000  Grand  Trunk  of  Canada  Bgnd  7% 1.000.00 


),3SS.1S 


CHARLES  M.   HITCHCOCK  FT'ND. 

January  10,  1021 — Balance  Central  Savings  Bank .$210.00 

April  1,  1921 — Interest  Central  Savings  Bank.  October- April ...  .  P.. .37 

May  IS.  1921— Interest  10-."')00  Regents  T'.  of  Md.  .5%  Bonds 12.-..00 

November  17.  1921— Interest  10-500  Regents  T'.  of  Md.  5%  Bonds.  12.">.0<' 

October  1,  1921— Interest  Central  Savings  Bank,  April-Oct 2.r,,3 


Deduct : 

June  13,  1921— Scholarship.  J.  P.  Franklin .$125.00 

June  13,  1921— Scholarship,  W.  W.  Wilson 125.00 


$405.96 


2.50.00 


January  1,  1922 — Balance  Central  Savings  Bank .$215.96 

This  Fund  consists  of: 
10-500  Regents  T'niversity  of  Maryland  5%  Bonds 5,000  00 


$5,215.96 


LEON  FRANK  FUND. 

January  10,  1921— Balance  Central  Savings  Bank $116.7S 

April  1,  1921 — Interest  Central  Savings  Bank.  October-April....  l.$5 

October  1.  1921 — Interest  Central  Savings  Bank.  April-October. .  1..53 

January  1,  1922— Interest  on  all  Bonds  to  date 13.5.tH) 


$255.16 


Deduct : 
January  24,  1921 — Adjustment  of  Int.  Exc.  of  Newburgh 

L.  H.  &  P.  Co.  for  Cent.  Hudson  Gas  &  Elec.  Co $       .42 

June  13,  1921— Scholarship  D.   S.   Fisher 12.5.00 

125.42 

January  1.  1922- Balance  Central  Savings  Bank .<;i29.74 

This  Fund  consists  of: 

1      .500  Central  Hudson  <Jas  &  Elec.  Co.  7%  Debenture  B(md.  .  .  .  .500.(10 

1   L«X)0  St.  Jos.  H.  L.  &  P.  Co.  5%  Bond 1.000.(i(» 

1  1,000  Omaha  &  Council  Bluffs  R.  &  B  '1%  Bond l.Ooo.OO 

$2,029.74 


89 

LAW  FUND. 

January  10,  1021 — Balance  Central  Savings  Hank 

April  1,  1!J21 — Interest  Central  Savings  Bank.  Uctober-April .  . 
November  21,  l'.)21 — Interest  Central  Savings  Bank,  April-Oct. 

January  1,  1922 — Balance  Central  Savings  Bank 


.$16(j. 

.23 

8, 

.30 

3 

.3<J 

.$172 

.S3 

PHARMACY  FIND. 

January  10,  1921 — Balance  Central  Savings  Bank $4.j.'JN 

April  1,  1921— Interest  Central  Savings  Bank.  October-April .90 

November  21,  1921 — Interest  Central  Savings  Bank.  April-October  .9<J 

Januar.v  1.  1922 — Balance  Central   Savings  Bank $47. TS 

CHARLES  FRICK  FUND. 

Jaiuiary  10,  1921— Balance  Central  Savings  Bank .f39.s.97 

April  1.  1921 — Interest  Central  Savings  Bank,  October- April ... .  7.S7 

April  15,  1921— Interest  1-500  Fourth  Lil)erty  Loan  414% 10.62 

November  21,  1921 — ^Interest  Central  Savings  Bank,  April-Oct...  S.27 

January  1,  1922 — Balance  Central  Savings  B:iiik $425.73 

This  Fund  consists  of : 

1  500  Fourth  Liberty  Loan  4 Vi %  Bond 500.00 

$925.73 

RANDOLPH  WIXSLOW  FUND. 

January  10.  1921 — Balance  Central  Savings  Bank $70.00 

April  1.  1921 — Interest  Central  Savings  Bank,  October-April .97 

October  1,  1921 — Interest  Central  Savings  Bank.  April-October..  .53 

June  1.  1922 — Interest  on  all  Bonds  to  date 125.00 

$196.56 

Deduct : 

June  13,  1921 — Scholarship.  J.  J.  Krager 125.00 

January  1,  1922 — Balance  Central  Savings  Bank $71.56 

This  Fund  consists  of : 

5  .500  Regents  T'niversity  of  Maryland  5%  Bonds 2..500.0() 

$2,571.56 


90 

DAVID  STREETT  SCHOLARSHIP  FUND. 

June  10,  10i;i — Balance  Central  Savings  Bank $35.1G 

April  1,  1921 — Interest  Central  Savings  Bank.  October-April....  .60 

November  21,  1921 — Interest  Central  Savings  Bank,  April-Oct...  .75 

January  1.  1922— Interest  on  all  Bonds  to  date 13.69 


January  1.  1922 — Balance  Central  Savings  Bank $50.20 

This  Fund  consists  of: 

3  100  First  Liberty  Loan  3V2%  Bonds 300.00 

1  100  Second  Liberty  Loan  4^%  Bond 100.00 

1     50  Fourth  Liberty  Loan  41/4%  Bond 50.00 


$500.20 


CATHERINE  GIBSON  FUND. 

January  10.  1921 — Balance  Central  Savings  Bank $613.S1 

April  1,  1921— Interest  Central  Savings  Bank,  October- April 12.00 

October  1,  1921— Interest  Central  Savings  Bank.  April-October.  13.00 

January  1,  1922— Interest  on  all  Bonds  to  date 60.62 

January  1,  1922- Balance  Central   Savings  Bank $699.43 

This  Fund  consists  of: 

2  50O  Regents  University  of  Maryland  5%  Bonds 1,000.00 

1  500  Fourth  Liberty  Loan  414%  Bond 500.00 


$2,199.43 


TOTAL  PAR  VALUE  ON  BOOKS  OF  ALL  FUNDS. 

i'aculty  of  Physic  Fund $34,456.02 

General   Endowment  Fund 12,584.29 

Hemmetei-  Fund  6,38S.1S 

Charles  M.  Hitchcock  Fund 5.215.96 

Leon  Frank  Fund 2,629.74 

Randolph  WLnslow  Fund ■ 2,571.56 

Catherine  Gibson  Fund 2.199.43 

Leo  Karliusky  Scholarship  Fund 3.000.00 

David  Streett  Scholarship  Fund 500.20 

Charles  Frick  Fund 925.73 

Pharmacy  Fund 47.78 

Law  Fund  172.83 

Dental   Fund    25.70 

$70,717.42 


91 

B.  Merrill  Hopkinson,  M,  D., 

Secretary-Treasurer. 


January  9,  1922. 


Since  the  above  report  was  made,  the  Trustees  have  received  a 
check  for  one  thousand  dollars  from  the  Daughters  of  the  Ameri- 
can Eevolution  to  endow  a  bed  in  the  Maternity  Ward  of  the 
Hospital. 

B.  Merrill  HopKiNsoisr,  M.  D., 

Secretarij-Treasurer. 


Main  University  Building. 


92 
EDITORIAL. 

The  Leo  Karlinsky  Scholaeship. 

Friends  of  the  Medical  Department  will  be  g'lad  to  hear  that 
Mrs.  Leo  Karlinsky  has  given  to  the  Board  of  Trustees  of  the 
Endowment  Fund  $o,000.00  for  the  establishment  of  a  scholarship 
in  memory  of  her  linsband,  Doctor  Leo  Karlinsky,  class  of  1006, 
who  died  Jnne  13th,  1921,  aged  36  years.  It  was  both  a  most 
gracious  as  well  as  acceptable  gift  coming  as  it  does  on  the  thres- 
hold of  the  reorganization  of  the  University.  We  hope  that  Mrs. 
Karlinsky's  example  will  be  followed  by  many  more  of  our  well- 
wishers.  Money  thus  invested  works  perpetually  and  besides  help- 
ing the  University  also  helps  a  student  to  obtain  an  education. 
The  Bulletin  takes  this  opportunity  to  thank  Mrs.  Karlinsky  for 
her  most  generous  gift. 

Old  University  Building  Gutted  by  Fire. 

Our  alumni  will  regret  to  hear  that  Saturday,  February  25, 
1922,  the  main  University  building  was  visited  by  fire  which 
gutted  the  lecture  halls.  Fortunately  the  damage  was  limited  to 
Chemical  and  Anatomical  Halls.  I^o  cause  could  be  determined 
for  its  origin.  It  started  beneath  Chemical  Hall  and  had  soon 
gained  such  headway  that  the  whole  building  seemed  doomed. 
We  all  love  this  old  building  which  is  now  more  than  a  hundred 
years  old.  It  was  begun  May  7,  1812,  and  was  so  far  completed 
as  to  be  used  for  lecture  purposes  at  the  beginning  of  the  ensuing 
session.  Though  it  is  now  an  antiquated  structure  at  the  time  of 
its  completion  it  was  the  finest  structure  devoted  to  medical  edu- 
cation in  the  !New  World.  It  is  constructed  on  the  plan  of  the 
Pantheon  at  Rome  and  is  today  still  one  of  the  notable  landmarks 
of  the  city. 

All  ALu:\rNi,  Take  Xottce. 

The  Annual  Meeting  of  the  Alunmi  Association  is  to  be  held  in 
Osier  Hall,  Medical  and  Chirurgical  Faculty  Bldg.,  1211  Cathe- 
dral Street,  Baltimore,  May  29,  1922,  at  8  P.  M.,  sharp.  Besides 
routine  business  and  speeches  by  representative  men,  officers  will 
be  elected  for  the  ensuing  year. 

The  Alumui  Association  is,  as  you  are  well  aware,  composed  of 
the  graduates  of  the  three  schools  which  were  combined  into  what 
is  now  known  as  the  medical  school  of  the  TTniversity  of  IMaryland. 
What  is  well  known  and  as  often  said,  a  school  will  become  just 
as  areat  as  its  alumni  want  it  to  become.     It  thcrefoi'e  behooves 


93 

our  alumni  to  bear  in  mind  that  the  future  greatness  of  our  Alma 
jMater  is  in  their  keeping.  We  do  not  come  to  you  seeking  money, 
but  we  do  demand  j^our  hearty  moral  support.  The  people  of 
Maryland  want  a  great  ITniversit}-  and  are  carefully  scrutinizing 
the  efforts  being  made  to  place  this  school  on  a  University  basis. 
To  accomplish  this,  financial  support  must  be  forthcoming  from 
the  State.  Past  Legislatures  have  been  very  liberal  in  their  aid, 
but  it  is  imperative  that  the  next  Legislature  gTant  larger  bene- 
ficences, if  the  University  of  Maryland  hopes  to  keep  abreast  of  the 
other  gTeat  state  universities.  With  united  forces  the  unattainable 
is  attainable,  the  insurmountable  surmountable,  so  turn  out  in  full 
force  and  show  the  public  we  are  in  earnest. 

Clinics  Avill  be  given  May  29,  30  and  31  at  the  Mercy  and 
University  Hospitals  by  members  of  the  staff. 

The  class  of  1912  will  hold  its  tenth  reunion.  The  details  are 
in  the  hands  of  Dr.  M.  L.  Lichtenberg,  2224  Madison  Avenue, 
chairman  of  the  local  committee  on  arrangements. 

Your  executive  committee  in  consultation  with  the  deans  of  the 
various  departments  decided  to  hold  a  joint  banquet  of  the  several 
schools  constituting  the  X'niversity  of  Maryland. 

The  Annual  Banquet  will  be  held  at  the  City  Club,  Munsey 
Bldg.,  S.  E.  corner  of  Calvert  and  Fayette  Streets,  at  8  P.  M., 
May  31,  1922 ;  price  per  cover,  $3.00.  As  the  seating  capacity  is 
somewhat  limited  requests  for  reservations  cannot  be  accepted 
after  May  29.  In  order  that  the  banquet  committee  may  make 
proper  provision  for  its  guests,  it  urges  all  those  who  wish  to  at- 
tend to  send  their  check  at  once  to  Frank  L.  Black,  treasurer,  2S30 
W.  ]Sroi*th  Avenue,  Baltimore,  ^Id. 

A  ticket  of  admission  will  be  mailed  only  to  those  whose  accept- 
ance is  accompanied  with  the  price  of  the  subscription. 

President J.  B.  Schwatka,  M.  D. 

Vice-Presidents J.  M.  H.  Rowland,  M.  D. 

R  P.  Bay,  M.  D. 

Guy  Steelle,  M.  D. 

Secretary W.  S.  Love,  j\L  D.,  836  W.  Xorth  Ave. 

Treasurer C.  U,  Smith,  M.  D. 

Necrologist W.  J.  Todd,  M.  D. 

Advisory  Council .  .  .R.  Wijs^slow,  M.  D. 

R.  L.  Mitchell,  M.  D. 

W.  J.  Todd,  M.  D. 

Hiram  Woods,  M.  D. 

F.  R.  Maloxe,  M.  L>. 


94 

Senior  Class. 

Hospital  Appoinf>ments  Reported  to  Date. 

BAILEY,  H.— Hebrew  Hospital. 

BUCHNESS,  A.  V.— University  Hosptial. 

CHAMPE,  Jr.,  I.  P.— University  Hospital. 

DOSHAY,  L.  J.— Staff,  Mercy  Hospital. 

FLEISCHMANN,  B.— City  Hospital,  New  York  City. 

FRITZ,  J.  D.— St.  Mark's  Hospital,  175  Second  Ave.,  New  York. 

FULTON,  WM.  J.— University  Hospital. 

GOLDMANN,  B.  A.— Allegheny  General  Hosptial,  Pittsburgh,  Pa. 

GOLLICK,  WM.  A.— Maryland  General  Hospital. 

GORDON,  E.— Maryland  General  Hospital. 

GREENBAUM,  L.  H.— Hebrew  Hospital. 

GROFF,  MORRIS.— Brownville  and  East  New  York  Hospital. 

HALLEY,  GEO.  C— University  Hospital. 

HATFIELD,  D.  S.— Maryland  General  Hospital. 

HOLLISTER,  WM.— University  Hospital. 

HUFF,  WM.— University  Hospital. 

INGRAM,  D.  N. — ^Western  Pennsylvania  Hospital,  Pittsburgh,  Pa. 

KEEFE,  GEO.  G.— St.  Francis  Hospital,  Hartford,  Conn. 

KERDASHA,  G.  S.— Jersey  City  Hospital,  Jersey  City,  N.  J. 

KRAGER,  J.  J.— St.  Joseph's  Hospital. 

KINKOWSKI,  A.— St.  Joseph's  Hospital. 

LANG,  M.  C. — University  Hospital. 

LAWSON,  L.  W.— University  Hospital. 

LINKE,  J.  P. — Muhlenberg  Hospital,  6  mos.;  University  of  Berlin,  18  mos. 

McCOY,  C.  G.— Mercy  Hospital. 

MERCIER,  A.  S.— St.  Joseph's  Hospital. 

MIDDLEMISS,  WM.  R.— County  Hospital,  Salt  Lake  City,  Utah. 

MORGAN,  E.  N.— Buffalo  City  Hospital,  Buffalo,  N.  Y. 

NOLL,  LOUIS— Hebrew  Hospital. 

O'CONNOR,  J.  A.— St.  Joseph's  HospitaL 

PETERS,  J.  R.— Mercy  Hospital. 

PITTMAN,  H.  L. — Maryland  General  Hospital. 

PULLEN,  G.  F. — Mountainside  Hospital,  Montelau,  N.  J. 

RHODES,  B.  M.— University  Hospital. 

RUDISILL,  J.  D.— Mercy  Hospital. 

SALZBERG,  A.— Hospital  for  Women  of  Maryland. 

SAPORITO,  A.  R.— Mercy  Hospital. 

SEKERAK,  A.  J.  F.— St.  Francis  Hospital,  Bridgeport,  Conn. 

SHANNON,  G.  E. — Resident  Obstetrician,  Maryland  General  Hospital. 

SHAPIN,  SYDNEY— Volunteer  Hospital,  New  York. 

SHAPIRO,  L.  M.— Grace  Hospital,  New  Haven,  Conn. 

STOUT,  P.  D.— Ohio  Valley  General  Hospital. 

STOVIN,  J.  S.— Governeur  Hospital,  New  York. 

TRYNIN,  A.  H.— Kings  County  Hospital,  New  York. 

WARFIELD,  J.  C— Women  of  Maryland,  Hospital  for. 

WILSON.  T.  K.— University  Hospital. 


95 
MARRIAGES. 

Dr.  Harry  M.  Stein,  class  of  1914,  for  three  years  superinten- 
dent of  the  University  Hospital,  Baltimore,  and  a  member  of  the 
A.  E.  F.  in  France,  was  married  October  17,  1921,  to  Miss  Mar- 
guerite Eugenia  Risley,  class  of  1917,  University  Hospital  Train- 
ing School  for  Nurses  and  until  recently  supervisor  of  the  operat- 
ing rooms,  University  Hospital.  Dr.  and  Mrs.  Stein  reside  at 
J  315  Mt.  Royal  Avenue,  Baltimore,  Md. 

Dr.  Benjamin  Bruce  Brumbaugh,  class  of  1916,  of  Elkridge, 
Md.,  was  married  ISTovember  5,  1921,  to  Miss  Miriam  Lee  Smith, 
daughter  of  Mrs.  William  Lee  Smith,  of  Baltimore.  Dr.  and 
Mrs.  Smith  will  reside  at  Elkridge,  Md. 

Dr.  Charles  Carrol  Habliston,  class  of  1914,  of  the  Medical 
l>epartment.  University  of  Maryland,  was  married  September  1  7, 
1921,  to  Miss  Sasa  Louise  Sbarp,  daughter  of  Mr.  and  Mrs.  Louis 
Dent  Sharp,  of  Fort  Benton,  Montana.  Dr.  and  Mrs.  Habliston 
have  taken  up  their  residence  at  the  Montreal,  Baltimore,  Md. 

Dr.  George  Edward  Wells,  class  of  1921,  of  Baltimore,  was 
married  September  26,  1921,  to  Miss  Pauline  Stotler  Wilson,  of 
Keyser,  W.  Va. 

Dr.  Alexander  J.  Gillis,  of  Baltimore,  was  married  September 
28,  1921,  to  Miss  Helen  Costello,  of  Baltimore. 


DEATHS. 


Dr.  Young  Hance  Bond,  class  of  1867,  former  president  of  the 
Medical  Society  of  St.  Louis,  member  of  the  Board  of  Health ; 
founder  1890  and  president  of  the  Marion  Sims  College  of  Medi- 
cine, St.  Louis,  until  it  became  the  medical  department  of  St. 
Louis  LTniversity  in  1903,  of  which  he  was  dean  for  three  years; 
founder  of  the  St.  Louis  Dental  College ;  died  February  5,  1922, 
from  angina  pectoris,  aged  75. 

Dr.  William  Ctilbert  Lyon,  class  of  1907,  Lieutenant,  M.  C, 
U.  S.  !N".,  retired,  died  at  his  home,  Valatie,  IST.  Y.,  Februarv  6, 
1922,  aged  42. 

Dr.  William  Rowley,  Gloucester,  Mass.,  B.  M.  C,  class  of  1893, 
died  January  29,  1922,  aged  57. 

Dr.  Arthur  Blake  Clarke,  class  of  1906,  died  January  31  from 
lobar  pneumonia,  aged  51. 

Dr.  John  C.  Anderson,  Greenwood,  Va.,  P.  &  S.,  class  of  1876, 
died  ]!^ovember  25,  1921,  from  carcinoma  of  the  prostate,  aged  70. 


96 

Doctor  William  Eilaii,  class  of  1879,  died  suddenly  Febrnarv 
1.  1922,  from  heart  disease,  aged  68. 

Doctor  William  Samuel  Hutchinson,  Anderson,  S.  C,  B.  M.  C, 
class  of  1897,  died  December  29,  1921,  of  chronic  nephritis,  aged 
46. 

Doctor  E.  X.  Crawford,  Cecilton,  Md.,  P.  6c  S.,  class  of  1874, 
died  March  3,  1922,  from  appendicitis,  aged  70. 

Doctor  Silas  W.  Hunter,  Wiseburg,  Md.,  P.  &  S.,  class  of  1874, 
died  January  19,  1922,  aged  72,  from  carcinoma  of  the  stomach. 
He  "wasi  formerly  a  resident  physician  at  Bayview  Hospital,  Bal- 
timore. 

Doctor  Jacob  Jones  Wilson,  Cumberland,  Md.,  P.  &  S.,  1871, 
president  of  the  staff  of  the  Western  Maryland  Hospital,  Cum- 
berland, died  February  24,  1922,  aged  73. 

Dr.  Edward  Martin  W^ise,  class  of  1877,  of  Baltimore,  died 
February  5,  1922,  aged  67.  He  had  retired  as  an  active  practi- 
tioner nine  years  ago. 

Doctor  William  L.  Mauldin,  class  of  1901,  of  Greenville,  S.  C, 
died  March  3,  1922.  He  had  been  in  failing  health  for  three 
years.  Doctor  Mauldin  was  born  April  18,  1877.  Immediately 
after  graduating  he  located  in  Greenville,  where  he  succeeded  in 
building  a  lucrative  practice.  By  his  cheerful  temperament,  kind- 
ness and  considerateness  he  had  endeared  himself  to  a  large  circle 
of  friends  and  patients. 

Doctor  B.  B.  Brown,  Sr.,  class  of  1867,  a  widely  known  g}'ne- 
cological  specialist,  of  Baltimore,  died  March  10,  1922,  aged  79, 
from  the  infirmities  of  age.  He  was  one  of  the  founders  and 
professor  of  gynecology  in  the  Woman's  Medical  College,  Balti- 
more. 

Doctor  Clarence  H.  Scoville,  Xew  Canaan,  Conn.,  B.  M.  C, 
class  of  1892,  died  recently  from  chronic  nephrities,  aged  70. 

Doctor  Frank  G.  Wilson,  class  of  1896,  of  Gastonia,  N.  C,  a 
member  of  the  ]\Iedical  Society  of  the  State  of  Xorth  Carolina, 
died  November  13,  1921,  from  cerebral  hemoi-rhage,  aged  48. 

Doctor  John  Luther  McJ\Iillan,  Red  Springs,  X.  C,  class  of 
1881,  died  jSTovember  8,  1921,  from  heart  disease,  aged  66. 

Doctor  Edward  Hamilton  Holbrook,  class  of  1868,  of  Los 
Angeles,  died  suddenlv  Februarv  1,  11>22,  aged  76. 

Dr.  Wyatt  Eeid  Arnold,  Bedford,  Va.,  P.  &  S.,  class  of  1886, 
member  of  the  Medical  Society  of  Virginia,  died  January  21, 
1922,  aged  56,  from  tubercnlosis. 

Dr.  William  Pierce  ^fatthews,  Sacramento,  Cal.,  Washington 
University  School  of  Medicine,  class  of  1868,  died  December  29, 
1921,  from  cerebral  hemon*hage,  aged  78. 

Dr.  Ramon  C.  Deliz,  a  native  of  Porto  Rico  and  formerly  resi- 
dent gynecologist   in   the   l^niversity  Hospital,   died   recently  of 


97 

typhoid  fever.  He  is  survived  by  his  wife,  Mrs.  Helen  M,  Deliz, 
a  daughter  of  Mr.  and  Mrs.  Louis  C.  Morseberger,  of  Baltimore. 

Dr.^Jolm  Frederick  Wright,  of  Keezletown,  Va.,  P.  &  S.,  1876, 
and  a  member  of  the  Medical  Society  of  Virginia,  died  June  26, 
1U21,  aged  68. 

Dr.  Arthur  White,  Rockport,  Ind.,  class  of  1854,  died  August 
11,  1921,  aged  89.    He  served  as  a  surgeon  in  the  Civil  War. 

Dr.  Melvin  B.  Squires.,  of  Flatwood,  W.  Ya.,  P.  &  S.,  1893,  was 
killed  September  26,  1921,  in  a  railway  accident,  aged  53. 

Dr.  Sherman  M.  Kline,  of  Scranton,  la.,  P.  &  S.,  1900,  died 
September  22  from  diabetes,  aged  47. 

Ulysses  Grant  M.  McHugh,  M.  D.,  Pittsburgh,  Pa.,  B.  M.  C, 
1898,  died  ^November  2,  1921,  from  pleuropneumonia,  aged  52. 

Frank  Paul,  M.  D.,  of  2401  East  Preston  St.,  Baltimore,  Md., 
a  graduate  of  the  College  of  Physicians  and  Surgeons,  died  JSTo- 
vember  11,  1921,  from  peritonitis.  Dr.  Paul  was  bom  in  Balti- 
more and  was  unmarried.  After  graduation  he  served  a  year  as 
an  interne  in  the  Mercy  Hospital.  He  then  went  to  Milwaukee 
where  he  served  some  time  as  a  resident  in  a  hospital,  thence  he 
returned  to  Baltimore  and  joined  the  staff  of  St.  Joseph's  Hos- 
pital. He  then  again  went  West,  this  time  to  Iowa.  A  year 
later  he  returned  to  Baltimore  and  became  identified  with  Di\ 
Bloodgood  in  the  pathological  department  at  the  Johns  Hopkins 
Jlospital. 

Lewis  H.  Gundry,  M.  D.,  of  Relay,  Md.,  P.  &  S.,  1890,  died 
September  15,  1921,  of  a  complication  of  diseases,  aged  53.  He 
was  born  in  Dayton,  Ohio,  where  he  received  his  early  education. 
After  graduating  in  medicine  he  specialized  in  the  treatment  of 
nervous  and  mental  diseases.  Many  years  ago  he  opened  the 
-Relay  Sanatorium,  which  institution  was  devoted  to  the  manage- 
ment of  nervous  and  mental  diseases  only.  He  was  a  brother  of 
Dr.  Richard  F.  Gundry  of  Catonsville,  Md. 

Cary  B.  Gamble,  M.  D.,  of  Baltimore,  Md.,  class  of  1846,  died 
]^ovember  8,  1921,  at  his  home  from  the  infirmities  of  old  age, 
aged  97.  He  was  the  father  of  Dr.  Cary  B.  Gamble,  Jr.,  and 
practiced  in  Baltimore  from  the  end  of  the  Civil  War  until  re- 
tirement 20  years  ago.  At  the  time  of  his  death  he  was  the 
oldest  living  alumnus  of  the  University  of  Maryland,  School  of 
]\redicine.  He  led  an  active  and  varied  career,  witnessed  the  many 
revolutionary  changes  in  medicine  of  the  19th  Century  and  died 
beloved  and  respected  by  all  of  those  who  knew  him.  For  a  sketch 
of  his  life  see  the  October  number  of  the  Bulletin  (editorial).  We 
sincerely  regret  that  his  death  has  followed  the  editorial  notice  so 
quicklv. 

Clinton  H.  Coy,  M.  D.,  iSTapoleon,  Ohio,  P.  &  S.,  1888,  died 
August  9,  1921,  after  an  illness  of  three  months,  aged  66. 


98 

Robert  B.  Patrick,  Wavcross,  Ga.,  class  of  1912,  died  August  8, 
1921,  following  an  operation  for  appendicitis,  aged  35. 

Doctor  James  H.  Jarrett,  at  the  time  of  his  death  the  oldest 
living  alumnus  of  the  University  of  Maryland,  class  of  1852,  of 
Towson,  Md.,  died  February  12,  1922.  He  was  the  son  of  Luther 
M.  Jarrett,  and  was  bom  at  Jarrettsville,  Md.,  in  1832.  At  the 
time  of  his  death  he  was  in  his  90th  year.  Immediately  after 
graudating  he  began  the  practice  of  medicine  in  Jarretsville.  He 
served  as  a  member  of  the  House  of  Delegates  in  1855-1856, 
When  President  Lincoln  issued  the  call  for  volunteers  he  gave  up. 
his  practice  and  entered  the  Union  Army,  while  a  brother.  Dr. 
Martin  L.  Jarrett,  went  to  Virginia  to  join  General  Lee.  At 
first  he  served  with  Purnell's  legion,  afterwards  joining  the  7th 
Maryland  Regiment.  After  the  war  Dr.  Jarrett  located  at  Tow- 
son  and  resumed  the  practice  of  medicine.  He  was  a  fine  example 
of  the  old  country  doctor,  a  fast  disappearing  type  of  the  old 
Southern  gentleman,  a  highly  respected  and  beloved  member  of 
the  profession  and  of  the  community  in  which  he  labored.  During 
Dr.  Jarrett's  career  he  saw  many  changes  and  advances  in  his 
chosen  profession.  Anesthesia  had  been  discovered  and  anesthetics 
employed,  but  medicine  and  surgery  such  as  it  is  today  was  un- 
dreamt of.  The  miscTOScope  was  a  curiosity.  Histology  and  em- 
bryology were  not  taught.  Antiseptic  and  aseptic  surgery  were  a 
later  development.  Only  operations  of  necessity  and  urgency  were 
performed  and  surgery  such  as  we  know  it  was  unknown.  He  saw 
and  participated  in  the  most  revolutionary  changes  in  medicine. 

Dr.  Robert.  Lee  Blake,  formerly  of  Baltimore  B.  M.  C,  class 
of  1905,  and  a  son  of  the  late  Professor  of  Surgery,  John  D, 
Blake,  died  April  21,  1922.  He  practiced  medicine  in  Baltimore 
until  two  years  ago  when  he  retired  owing  to  ill  health.  Since  that 
time  he  has  been  living  with  his  brother,  Dr.  J.  D,  Blake,  Jr.,  in 
Middlesex  County,  Virginia.  Dr.  Herbert  C.  Blake,  1014  W. 
Lafayette  Avenue,  Baltimore,  is  a  brother. 

Dr.  Charles  W.  Gravatt,  of  Port  Royal,  Va.,  P.  &  S.,  1870,  for- 
merly a  surgeon  in  the  United  States  Navy,  died  April  14,  1922, 
aged  72. 

Dr.  George  B.  Malone,  of  Memphis,  Tenn.,  Washington  L^ni- 
versity  School  of  Medicine,  class  of  1872,  a  Confederate  Veteran, 
died  April  13,  1922,  aged  77,  from  cerebral  hemorrhage. 

Dr.  Robert  G.  Black,  Vancouver,  Washington,  P.  &  S.,  1886, 
died  April  16,  1922,  aged  58. 

Dr.  Thomas  Benton  Ashby,  Mt.  Airy,  N.  C,  P.  &  S.,  1885,  died 
April  10,  1922,  aged  50,  from  heart  disease. 

Dr.  Simon  P.  Rentz,  Branchville,  S.  C,  class  of  1891,  died 
March  22,  1922,  from  a  broken  neck  incurred  in  an  automobile 
accident. 


99 

Dr.  George  A.  Fleming,  of  Baltimore,  Md.,  class  of  1884,  died 
April  17,  1922,  from  heart  disease,  aged  60. 

Dr.  Henry  B.  Thomas,  of  Baltimore,  class  of  1888,  died  April 
2,  1922,  from  heart  disease,  aged  57.  One  of  Baltimore's  most 
useful  citizens  has  gone. 

Dr.  James  G.  Turner,  Houghton,  Mich.,  class  of  1878,  died 
suddenly  April  4,  1922,  aged  65,  from  heart  disease. 

Dr.  Cyrus  F.  Bowers,  Fairmont,  W.  Va.,  B.  M.  0.,  1882,  died 
November  18,  1921,  aged  79. 

Dr.  Thomas  E.  Krum,  Reading,  Pa.,  P.  &  S.,  1886,  died  No- 
vember 21,  1921,  following  a  nervous  breakdown,  aged  61. 

Dr.  Samuel  R.  Gregory,  Mount  Union,  Pa.,  P.  &  S.,  1896,  died 
March  9,  1922,  aged  51,  from  pneumonia. 

Dr.  William  Henry  Davis,  Millerton,  IN".  Y.,  class  of  1903,  died 
March  12,  1922,  aged  42. 

Dr.  Arthur  Joseph  Campbell,  Middletown,  Conn.,  P.  &  S., 
1885,  died  March  5,  1922,  aged  65. 

Dr.  Eli  Sheridan  Parsons,  Slingerlands,  :?^.  Y.,  P.  &  S.,  1892, 
Long  Island  College  Hospital,  1895,  died  March  22,  1922,  from  a 
fractured  skull  received  in  an  automobile  accident  March  21,  1922, 
aged  54. 

Dr.  Wilson  McClellan,  Ashland,  Ohio,  B.  M.  C,  1895,  served  in 
the  World  War,  died  recently,  aged  64. 

Dr.  Reuben  T.  Ramsey,  Gretana,  Va.,  P.  &  S.,  1879,  died  Feb- 
ruary 28,  1922,  aged  64. 

Dr.  Harvey  Bowers,  Sugar  Grove,  W.  Va.,  class  of  1893,  died 
March  2,  1922,  from  pneumonia. 

Dr.  Edward  K  Crawford,  Cecilton,  Md.,  P.  &  S.,  1874,  died 
March  4,  1922,  aged  70,  from  appendicitis. 

Dr.  William  Hall  Thomas,  Steeles  Tavern,  Va.,  B.  M.  C,  1889, 
died  March  11,  1922,  aged  63,  from  cerebral  hemorrhage. 

Dr.  Frederick  Lincoln  Johnson,  Stanton,  ISJ".  J.,  P.  &  S.,  1889, 
died  March  8,  1922,  aged  57,  from  pneumonia. 

Dr.  Zacharias  D.  Ridout,  of  Anne  Arundel  County,  Md.,  class 
of  1869,  died  May  7,  1922,  from  a  general  breakdovtai. 


BOOK  REVIEWS. 

Ephraim  McDowell,  Father  of  Ovariotomy  and  Founder  of  Ab- 
dominal Surgery.     By  August  Schachner,  M.  D.,  F.  A. 
C.  S.     Philadelphia  and  London:    J.  B.  Lippincott  Com- 
pany, 1921. 
This  is  a  piece  of  patriotic  literary  work  by  Dr.  Schachner,  of 
Louisville,  Ky.,  rescuing  from  oblivion  many  of  the  pertinent  facts 
connected  with  the  history  of  Dr.  Ephraim  McDowell,  the  origina- 


100 

tor  of  ovariotomy  aud  tlie  founder  of  abdominal  siirgerv,  with  a 
short  appendix  on  the  life  of  Mrs.  Jane  Todd  Crawford,  the  pa- 
tient upon  whom  the  first  ovariotomy  in  the  history  of  the  world 
was  performed.  It  has  been  thought  by  many  that  the  first  patient 
upon  whom  McDowell  operated  upon  for  ovaritomy  was  a  negress. 
This  is  a  mistake  as  Mrs,  Crawford  was  a  respectable  white  woman 
from  whom  has  descended  some  of  the  most  prominent  families 
of  Kentucky.  It  is  a  book  well  worth  careful  study,  both  from  its 
historical  viewpoint  as  well  as  man}^  side  lines  of  historical  in- 
terest. Dr.  Schachner  has  performed  a  service  of  the  greatest 
value.  He  causes  us  to  pause  for  a  while  and  pay  homage  to 
those  who  have  made  abdominal  section  the  boon  it  is  today  to  so 
many  suffering  with  intraabdominal  disorders  of  one  sort  or  an- 
other. Little  do  most  of  us  realize  the  debt  we  are  under  to  our 
predecessors  for  the  knowledge  they  have  handed  down  to  us  with- 
out let  or  hindrance.  The  womanhood  of  the  world,  irrespective 
of  race,  creed  or  color  are  indebted  for  renewed  health  and  happi- 
ness through  the  vision  of  this  truly  gTeat  American  surgeon :  and 
to  the  brave  Jane  Todd  Crawford.  Future  students  of  the  lives  of  ■ 
these  benefactors  of  the  human  race  are  perpetually  indebted  to 
Dr.  Schachner  for  the  collection  of  a  mass  of  data  not  available  to 
earlier  historians. 

Abdominal  Pain.     By  Prof.   Dr.  jSTorbert  Ortner,   Chief  of  the 
Second  Medical  Clinic  at  the  University  of  Vienna.   Trans- 
lated by  William  A.  Brams,  M.  D.,  formerly  Lieutenant 
Commander,  Medical  Corps,  U.  S.  IST.,  and  Dr.  Alfred  P. 
Luger,  First  Assistant,  Second  Medical  Clinic,  University 
of  Vienna.     ISTew  York:    Rebman  Company,  1922. 
It  is  pain  more  than  any  other  symptom  that  brings  the  patient 
to  the  doctor.     People  will  put  up  with  most  anything  but  pain, 
therefore  it  is  important  for  the  physician  to  be  able  to  properly 
interpret  the  significance  of  pain  and  especially  is  this  the  case 
when  applied  to  the  abdomen.     In  the  above  book  of  some  three 
hundred  and  fifty  odd  pag'es  the  author  discusses  the  symptom 
pain  as  it  is  met  with  in  the  various  intraabdominal  crises  as  well 
as  those  extraabdominal  conditions  which  cause  pain  in  the  alxlo- 
men.    It  contains  a  wealth  of  material  which  can  for  the  most  part 
only  be  obtained  by  a  wide  search  of  the  literature.    It  treats  a  live 
question  in  a  live  way.     It  gives  us  much  pleasure  to  reeonunend 
it  to  our  readers.  , 

Infant  Feeding.  By  Clifford  G-.  Grulee,  M.  D.,  LL.  D.,  Associate 
Professor  and  Acting  Head  Department  of  Pediatrics  at 
Rush  Medical  College.  Fourth  Edition,  Thoroughly  Re- 
vised. Octavo  of  397  pag-es,  illustrated.  Philadelphia  and 
London:  W.  B.  Saunders  Company,  1922.  Clotb,  $4.50 
net. 


101 

What  is  one  man's  food  is  another  man's  poison,  applies  to  the 
feeding  of  infants  as  well.  During  the  past  decade  great  strides 
have  been  made  in  the  feeding  of  the  adult,  equally  as  important 
advances  have  been  made  in  the  feeding  of  children.  Ko  two  chil- 
dren can  be  fed  exactly  alike,  therefore  feeding  by  rule  is  a  dead 
number  and  the  needs  of  each  child  must  be  determined  if  the 
baby  is  to  be  properly  nourished.  Grulee  takes  up  in  turn  the  anat- 
omy and  physiology  of  the  gastro  intestinal  tract;  absorption  and 
metabolism ;  the  bacteriology  of  the  gastrointestinal  tract ;  the  tech- 
nic  of  breast  nursing  of  the  normal  infant ;  artificial  foods  and  feed- 
ing; the  premature  child;  the  exudative  diathesis;  infant  feeding 
in  rickets;  infantile  scurvy;  infant  feeding  in  eczema;  congenital 
pyoloric  stenosis  and  pylorospasm,  etc.  The  author  has  had  wide 
experience  in  feeding  infants  as  well  as  teaching  students.  He  is 
therefore  well  informed  concerning  the  difficulties  confronting  the 
beginner  in  outlining  a  sensible  dietary.  Students  and  general 
practitioners  of  medicine  desirous  of  obtaining  a  sound  foundation 
in  modern  methods  of  baby  feeding  will  find  this  book  most  satisi- 
factory  either  as  a  text  or  reference  book. 

Psychoanalysis:  Its  Theories  and  Practical  Application.  By 
A.  A.  Brill,  Ph.  B.,  M.  D.,  Lecturer  on  Psychoanalysis  and 
Abnormal  Psychology,  New  York  University.  Third  Edi- 
tion, Thoroughly  Revised.  Octavo  of  468  pages.  Phila- 
delphia and  London:  W.  B.  Saunders  Company,  1922. 
Cloth,  $5.00  net. 

For  some  years  now  psychoanalysis  has  been  receiving  the  atten- 
tion of  both  the  medical  profession  and  the  layman.  As  early  as 
1895  Breuer  and  Freud  found  that  hysterical  symptoms  could  be 
traced  to  actual  psychic  traumata  which  the  patient  could  not  con- 
sciously recall,  but  which  could  be  readily  demonstrated  when  the 
patient  was  put  in  the  hypnotic  state.  In  other  words  hysteria  has 
an  actual  cause.  Breuer  and  Freud  then  concluded  that  these 
psychic  traumata  act  like  foreign  bodies  in  consciousness,  and 
even  long  after  their  occurrence  continue  to  exert  their  malign  in- 
fluence. Brill  outlines  in  his  book  how  these  ideas  become  im- 
pregnated in  the  mind  and  the  processes  by  which  the  psycho- 
analyst goes  about  unravelling  the  complex  pictures  into  their 
component  elements.  Whether  one  believes  the  theories  enumer- 
ated or  not,  a  careful  study  of  the  text  is  well  worth  the  time. 
The  author  not  only  discusses  the  question  of  dreams  but  many 
other  neusoses  in  a  most  convincing  manner  as  based  on  t*ome  re- 
pressed sexual  activity  and  adduces  many  examples  from  his  prac- 
tice as  proof  of  his  assertions.  Certainly  the  most  biased  physi- 
cian will  admit  that  the  class  of  patients  in  question  are  the  bane 
of  their  existence.     Therefore  any  suggestions  which  tend  to  their 


102 

relief  are  well  worth  while.  The  methods  of  procedure  suggested 
by  the  author  can  under  no  circumstance  do  harm,  consequently 
their  application  in  the  cure  of  an  individual  so  afflicted  are 
worthy  of  an  extended  trial  before  condemnation.  We  suggest 
that  every  general  practitioner  should  familiarize  himself  with 
a  working  knowledge  of  the  system  advocated  by  the  writer. 

A  Text-Book  of  General  Bacteriology.  By  Edwin  0.  Jordan, 
Ph.  D.,  Professor  of  Bacteriology  in  the  University  of 
Chicago  and  in  the  Rush  Medical  College.  Seventh  Edi- 
tion, Thoroughly  Revised.  Octavo  of  774  pages,  fully 
illustrated.  Philadelphia  and  London:  W.  B.  Saunders 
Company,  1921.     Cloth,  $5.00  net. 

During  the  past  few  years  many  additional  facts  have  been 
established  concerning  influenza,  pneumonia,  typhus  fever,  immu- 
nity and  cognate  subjects.  The  present  edition  of  this  book  con- 
cerns itself  mostly  with  these  changes,  so  that  it  now  has  been 
brought  up  to  the  state  of  efficiency  of  its  predecessors.  It  is  a' 
thoroughly  reliable  and  trustworthy  guide  to  the  study  of  bac- 
teriology whose  price  places  it  within  reach  of  all  interested  in  the 
subject  of  which  it  treats.  From  every  angle  it  is  an  exceptional 
example  of  the  book-makers  art.  Students  of  bacteriology'  will 
be  as  much  pleased  with  it  as  its  predecessors  and  will  find  it  of 
great  service  in  overcoming  the  intricacies  of  their  bacteriological 
studies.  We  know  of  no  better  moderate  priced  book  on  the  sub- 
ject. 

Diseases  of  the  Skin  and  Eruptive  Fevers.  By  Jay  Frank  Sham- 
berg,  M.  D.,  Professor  of  Dermatology  and  Syphilis,  Grad- 
uate School  of  Medicine,  University  of  Pennsylvania. 
Fourth  Edition,  Thoroughly  Revised.  Octavo  of  626 
pages,  265  illustrations.  Philadelphia  and  London:  W.  B. 
Saunders  Company,  1921.     Cloth,  $5.00  net. 

Shamberg-'s  Diseases  of  the  Skin  and  Eruptive  Fevers  has  al- 
ready made  its  mark  and  is  sufficiently  well  known  to  need  no  fur- 
ther recommendation.  This  edition  is  fully  up  to  the  standard  of 
its  predecessors  and  should  give  every  bit  as  much  satisfaction  to 
its  possessors.  Students  and  general  practitioners  will  find  that  it 
covers  the  field  sufficiently  well  for  their  purposes  and  in  under- 
standable English.  What  is  more  to  the  point  it  is  put  out  at 
popular  and  pre-war  price.  It  is  thoroughly  up-to-date,  well  illus- 
trated, and  reliable.  As  a  practical  moderate  priced  treatise, 
there  is  no  l^etter  on  the  market.  It  covers  both  the  usual  nnd  rare 
skin  lesions  in  sufficient  detail  for  practical  purposes.  It  gives  us- 
gi*eat  pleasure  to  recommend  it  to  our  readers. 


103 

A  Form  of  Record  for  Hospital  Social  Work.  By  Gertrude  L. 
Farmer,  Director,  Department  of  Social  Work  of  the  Bos- 
ton City  Hospital,  Boston,  Massachusetts.  1921.  Cloth, 
$1.50  net.  Philadelphia,  London  and  Montreal:  J.  B. 
Lippincott  Co. 

This  book  will  be  found  of  inestimatable  value  to  the  social 
worker  be  she  a  novice  or  an  old  hand  in  the  game.  The  record 
which  the  author  suggests  is  for  a  specialized  form  of  social  work, 
primarily  adapted  for  the  use  of  hospitals  dealing  with  large 
numbers  of  both  ward  and  out-patients.     Its  chief  purposes  are: 

1.  A  realization  that  all  hospital  social  record  writing  is  more 
or  less^  of  a  bugbear  to  the  case  worker. 

2.  The  evolving  of  a  scheme  of  recording  which  has  already 
appealed  to  many  as  more  efficient  for  hospital  social  work  than 
those  ordinarily  in  use. 

3.  A  demonstration  of  the  record  scheme  used  by  the  author. 

4.  A  collection  of  material  for  the  use  of  students  in  training 
for  hospital  social  work. 

The  form  of  record  used  by  the  author  is  based  on  the  indi- 
vidual rather  than  the  family.  Rightly  she  claims  it  is  the  indi- 
vidual who  is  most  intimately  concerned;  therefore  the  form  of 
record  employed. 

Those  having  to  do  with  the  indigent  in  and  out-patient  have 
come  to  thoroughly  realize  that  the  social  worker  is  as  necessary 
to  the  proper  handling  of  these  patients  as'  the  medical  service 
rendered.  Therefore  any  light  that  can  be  thrown  upon  the  sub- 
ject which  will  render  a  more  efficient  solving  of  the  problems  of 
the  social  worker,  is  indeed  a  welcome  addition  to  our  sources  of 
infoitnation.  A  careful  study  of  the  scheme  evolved  by  Gertrude 
L.  Farmer  should  be  of  material  help  to  each  and  every  hospital 
social  worker  and  a  most  welcome  addition  to  her  armamentarium. 
Social  work  is  no  longer  a  trade,  it  has  developed  into  a  highly 
specialized  profession.  The  problems  to  be  solved  are  many  and 
oftentimes  intricate.  To  accomplish  the  most  good  with  the  least 
expenditure  of  effort  and  money  is  the  object  of  the  highly  trained 
and  efficient  social  worker.  A  study  of  the  plan  evolved  in  this 
book  cannot  be  without  profit  to  those  concerned  in  this  phase  of 
modem  effort. 


104 


STATEMENT   OF   THE    OWNERSHIP,  3IANAGEMEM,  CIRCULATION. 
ETC.,  REQUIRED  BY  THE  ACT  OF  CONGRESS  OF  AUGUST  24, 1912. 

Of  OFFICIAL  PUBLICATION  OF  THE  UNIVERSITY  OF  MARYLAND, 
BULLETIN  OF  THE  SCHOOL  OF  MEDICINE,  published  4  times 
yearly  at  Baltimore,  Maryland,  for  April,  1922. 

State  of  Maryland,  ss.: 

Before  me,  a  Notary  Public  in  and  for  the  State  and  county  aforesaid, 
personally  appeared  Nathan  Winslow,  who,  having  been  duly  sworn 
according  to  law,  deposes  and  says  that  he  is  the  Editor  of  the  Official 
Publication  of  the  University  of  Maryland,  Bulletin  of  the  School  of 
Medicine,  and  that  the  following  is,  to  the  best  of  his  knowledge  and 
belief,  a  true  statement  of  the  ownership,  management  (and  if  a  daily 
paper,  the  circulation),  etc.,  of  the  aforesaid  publication  for  the  date 
shown  in  the  above  caption,  required  by  the  Act  of  August  24,  1912, 
embodied  in  section  443,  Postal  Laws  and  Regulations,  printed  on  the 
reverse  of  this  form,  to  wit: 

1.  That  the  names  and  addresses  of  the  publisher,  editor,  managing 

editor,  and  business  managers  are: 

Publisher:  University  of  Maryland,  Baltimore,  Md. 
Editor:  Nathan  Winslow,  Baltimore,  Md. 
Managing  Editor:  Nathan  Winslow,  Baltimore,  Md. 

Business  Managers:  R.  Winslow,  W.  S.  Gardner,  J.  M.  H.  Rowland, 
Baltimore,  Md. 

2.  That  the  owners  are:  University  of  Maryland  Medical  School. 

3.  That  the  known  bondholders,  mortgagees,  and  other  securtty 
holders  owning  or  holding  1  per  cent,  or  more  of  total  amount  of  bonds, 
mortgages,  or  other  securities  are:   (if  there  are  none,  so  state):  None. 

NATHAN  WINSLOW. 

Sworn  to  and  subscribed  before  me  this  20th  day  of  March,  1922. 

(Seal)  Eleanore    H.    Muhly. 

(My  commission  expires  May  1, 1922.) 


INDEX. 


Alumni  Association    80 

Annual  Appointments    39 

Board    of    Instruction G 

Board   of   Regents 4 

Calendar 2 

Consolidaiton   of    Schools 30 

Curriculum 48 

Dispensaries 36 

Dispensary    Staffs: 

Mercy  Hospital    17 

University    Hospital    12 

Endowment   Fund    79 

Expenses,    Students'     47 

Pees 44 

Graduates.   ...    28 

Hospitals : 

Franklin    Square    33 

James   Lawrence   Kernan 35 

Maternity    Hospital    of    the    Univer- 

city   of   Maryland 33 

Mercy   Hospital    32 

Mount  Hope  Retreat  for  the  Insane  35 

Municipal   Hospital    34 

Sheppard  and  Enoch  Pratt  Hospital 

for   the   Insane,    The 35 

St.  Vincent's  Infant  Asylum 35 

University    Hospital     31 

West    End    Maternity 34 

Laboratories  : 

Anatomical 37 


Biological    Chemistry     38 

Clinical    Pathology     38 

Histology    and    Embryology 38 

Pathology    and    Bacteriology 38 

Physiology 37 

Pharmacology 52 

Libraries 39 

Matriculates 24 

Medical   Council    5 

Postgraduate   Students    43 

Prizes 45 

Prizemen 29 

Requirements    for    Matriculation 40 

Rules 44 

Schedule 72 

Scholarships 46 

Special   Courses    45 

Staffs : 

City  Hospital  at  Bay  View 21 

James' Lawrence   Kernan   Hospital.  19 

Mercy   Hospital    14 

Nursey    and    Child's    Hospital 22 

St.  Vincent's  Infant  Asylum 23 

University    Hospital    10 

Training  School  for  Nurses; 

Mercy   Hospital    77 

University    Hospital    76 

University    Council    4 

University  of   Maryland,   Organiza- 
tion   of 3 


BULLETIN 

OF  THE 

University  of  Maryland  School  of  Medicine 

AND 

College  of  Physicians  and  Surgeons 

Successor  to  The  Hospital  Bulletln,  of  the  University  of  Maryland, 
Baltimore  Medical  College  News,  and  the  Journal  of  the  Alumni  Asso- 
ciation of  the  College  of  Physicians  and  Surgeons. 

Vol.  VII  JULY,  1922  No.  1 


ANNUAL  ANNOUNCEMENT. 

SESSION  1922-1923. 


CALENDAR 


1922-1923. 
SCHOOL  OF  MEDICINE. 

September  IS  to  25,  Inc. — Examinations  for  advanced  standing. 

October  2 — Regular  session  begins. 

November  30 — Closed  (Thanksgiving  Day). 

December  21 — Christmas  recess  begins  after  last  lecture  period. 

January  2 — Lectures  resumed  9  A.  M. 

February  22— Closed  (Washington's  Birthday). 

March  29 — Easter  recess  begins  after  last  lecture  period. 

April  3 — Lectures  resumed.     9  A.  M. 

June  9 — Commencement. 


ORGAlSriZATIOJSr 


THE    UNIVERSITY  OF   MARYLAND 

Control  of  the  University  of  Maryland  is  vested  in  a  Board  of 
nine  Eegents,  appointed  by  the  Governor  and  confirmed  by  the 
Senate  for  terms  of  nine  years  each.  The  general  administration 
of  the  University  is  vested  in  the  President.  The  University 
Council  is  an  advisory  body,  composed  of  the  President,  the 
Assistant  to  the  President,  the  Director  of  the  Agricultural 
Experiment  Station,  the  Director  of  the  Extension  Service,  and 
the  Deans.  The  University  Council  acts  upon  all  matters  having 
relation  to  the  University  as  a  whole,  or  to  co-operative  work 
between  the  constituent  gi^oups.  Each  school  has  its  own  Faculty 
Council,  composed  of  the  Dean  and  members  of  its  faculty; 
each  Faculty  Council  controls  the  internal  affairs  of  the  group  it 
represents. 

The  University  has  the  following  educational  organization : 

The  College  of  Agriculture, 

The  College  of  Engineering, 

The  College  of  Arts  and  Sciences, 

The  School  of  Medicine, 

The  School  of  Law, 

The  School  of  Denistry, 

The  School  of  Pharmacy, 

The  Cbllege  of  Education, 

The  College  of  Home  Economics, 

The  Graduate  School, 

The  Summer  School, 

The  Department  of  Physical  Education  and  Recreation, 

The  School  of  Commerce. 

The  Schools  of  Medicine,  Law,  Dentistry,  Pharmacy  and  Com- 
merce are  located  in  Baltimore;  the  others  in  College  Park,  Mary- 
land. 


BOARD  OF  REGENTS 

OF  THE 

UNIVERSITY  OF  MARYLAND. 

Samuel  M.  Shoemaker,  Esq.,  Chairman Term  expires  1925 

Robert  Grain,  Esq , Term  expires  192nt 

John  M.  Dennis,  Esq.,  Treasurer Term  expires  192a 

Dr.  Frank  J.  Goodnow Term  expires  1931 

John  E.  Raine,  Esq Term-expires  1930 

C.  r.  Geluer.  Esq Term  expires  1929 

Dr.  W.  W.  Skinner,  8ecretarij Term  expires  192S 

B.  John  Black,   Esq Term  expires  192T 

Henry  Holzapfel,  Jr.,  Esq  . Term  expires  1926- 


.Vlkert  F.  Woods,  A.JI..  D.Agk.,  LL.D.,  Prvsidnit  and  Executive  Officer. 


THE  UNIVERSITY  COUNCIL. 

Albert  F.  Woods,  A.M.,  D.Agr..  LL.D PresideuL 

H.  C.  Byrd,  B.S Assistant  .to  tlie  President 

P.  AY.  Zimmerman,  M.S Dean  of  the  College  of  Agriculture 

A.  X.  Johnson,  S.B Dean  of  the  College  of  Engineering- 

Frederick  E.  Lee,  Ph.D Dean  of  the  College  of  Arts  and  Science 

Henry  D.  Harlan,  LL.D Dean  of  the  School  of  Law 

J.  M.  H.  Rowland,  M.D Dean  of  the  School  of  Medicine- 

E.  Frank  Kelly,  Phar.D Dean  of  the  School  of  Pharmacy 

T.  O.  He.\twole,  M.D.,  D.D.S Dean  of  the  School  of  Dentistry 

IL  F.  CoTTERMAN,  M.S Dean  of  the  College  of  Education 

yi.  ;M\rie  Mount.  A.B Voting  Di-an  of  the  College  of  Home  Economics 

C.  <).  Appi.eman,  I'h.D Dean  of  the  Graduate  School 

H.  J.  Patterson,  1  ).Sc 1  Hrector  of  the  Experiment  Station 

Thomas  B.  Symons.  M.S.,  D..\gr Director  of  Extension  Service 

M.  A.  Clemens,  A.M 1  )irector  School  of  Coinmerce- 

and  I'.usiness  .Vdniiiiistration> 


UNIVERSITY  OF  MARYLAND 
SCHOOL  OF  MEDICINE 

AND 

COLLEGE  OF  PHYSICIANS  AND 
SURGEONS. 


MEDICAL  COUNCIL: 

ARTHUR  M.  SHIPLEY,  M.D.,  Sc.D. 

GORDON  WILSON,  M.D. 

HARRY  FRIEDENWALD,  A.B.,  M.D. 

WILLIAM  S.  GARDNER,  M.D. 

STANDI  SH  McCLEARY,  M.D. 

JULIUS  FRIEDENWALD,  A.M.,  M.D. 

J.  M.  H.  ROWLAND,  M.D. 

ALEXIUS  McGLANNAN.  A.M.,  M.D. 

BARTGIS  McGLONE,  A.B.,  Ph.D. 

HUGH  R.  SPENCER.  M.D. 

H.  BOYD  WYLIE,  M.D. 

CARL  L.  DAVIS,  M.D. 

WILLIAM  H.   SCHULTZ.  Ph.B..  Ph.D. 

MAURICE   C.   PINCOFFS.   S.B.,   M.D. 


BOAED  OF  INSTRUCTION 


BOARD  OF  INSTRUCTION. 

EMERITUS  PROFESSORS. 

Randolph  Winslow,  A.M.,  M.D.,  LL.D Surgery 

Samuel  K.  Mekrick,  M.D Rhinology  and  Laryngology 

George  W.  Dobbin,  A.B.,  M.D Obstetrics 

Hiram  Woods,  A.M.,  M.D Opthalmology  and  Otology 

Charles  G.  Hill,  A.M.,  M.D Psychiatry 

A.  C.  Pole,  M.D Anatomy 

J.  Frank  Crouch,  M.D Clinical  Ophthalmology  and  Otology 

Charles  O'Donovan,  A.M.,  M.D.,  LL.D. .  .Clinical  Medicine  and  Pediatrics 

John  R.  Winslow,  A.B.,  M.D Rhinology  and  Laryngology 

Edward  N.  Brush,  M.D Psychiatry 

John  C.  Hemmeter,  M.D.,  Ph.D.,  Sc.D.,  LL.D Clinical  Medicine 


L.  E.  Neale,  M.D.,  LL.D.,  Professor  of  Obstetrics. 

Arthur  M.  Shipley,  M.D.,  Sc.D.,  Professor  of  Surgery. 

Gordon  Wilson,  M.D.,  Professor  of  Medicine. 

William  Royal  Stokes,  M.D.,  Sc.D.,  Professor  of  Bacteriology. 

Harry  Friedenwald,  A.B.,  M.D.,  Professor  of  Opthalmology  and  Otology. 

Archibald  C.  Harbison,  M.D.,  Professor  of  Surgery. 

Caby  B.  Gamble,  Jr.,  A.  M.,  M.D.,  Professor  of  Medicine. 

William  S.  Gardner,  M.D.,  Professor  of  Gynecology. 

Standish  McCleary,  M.D.,  Professor  of  Pathology  and  Clinical  Medicine. 

Julius  Friedenwald,  A.M.,  M.D.,  Professor  of  Gastro-Enterology. 

J.  M.  H.  Rowland,  M.D.,  Professor  of  Obstetrics  and  Dean  of  the  Faculty. 

Alexius  McGlannan,  A.M.,  M.D.,  Professor  of  Surgery. 

Thomas  C.  Gilchrist,  M.R.C.S..  L.S.A.,  M.D.,  Professor  of  Dermatology. 

G.  Milton  Linthicum,  A.M.,  M.D.,  Professor  of  Diseases  of  the  Rectum 
and  Colon. 

W.  B.  Perry,  M.D.,  Professor  of  Clinical  Gynecology. 

TiLGHMAN  B.  Marden,  A.B.,  M.D.,  Professor  of  Histology  and  Embryology. 

J.  Mason  Hundley,  M.D.,  Professor  of  Clinical  Gynecology. 

R.  Tunstall  Taylor.  A.B.,  M.D.,  Professor  of  Orthopedic  Surgery. 

Jos.  E.  GicHNER,  M.D.,  Professor  of  Clinical  Medicine  and  Physical  Thera- 
peutics. 

Charles  W.  McElfbesh,  M.D.,  Professor  of  Clinical  Medicine. 

Irving  J.  Spear,  M.D.,  Professor  of  Neurology  and  Clinical  Psychiatry. 

C.  Hampson  Jones,  M.D.,  CM.  (Edinburgh),  M.D.,  Professor  of  Hygiene 
and  Public  Health. 

John  Ruhrah.  M.D.,  Professor  of  Pediatrics. 

Charles  F.  Blake,  A.M.,  M.D.,  Professor  of  Proctology. 


BOAED  OF  INSTRUCTION  7 

Frank  Dyer  Sanger,  M.D.,  Professor  of  Diseases  of  Throat  and  Nose. 

Bartgis  McGlone,  A.B.,  Ph.D.,  Professor  of  Physiology. 

H.  R.  Spencer,  M.D.,  Professor  of  Pathology. 

H.  Boyd  Wylie,  M.D.,  Professor  of  Biological  Chemistry. 

Carl  L.  Davis,  M.D.,  Professor  of  Anatomy. 

Wm.  H.  Schultz,  Ph.B.,  Ph.D.,  Professor  of  Pharmacology. 

S.  Griffith  Davis,  A.B.,  M.D.,  Professor  of  Anaesthesia. 

G.  Carroll  Lockard,  M.D.,  Professor  of  Clinical  Medicine. 

Charles  E.  Brack,  Ph.G.,  M.D.,  Professor  of  Clinical  Obstetrics. 

Harvey  G.  Beck,  M.D.,  Sc.D.,  Professor  of  Clinical  Medicine. 

Alberttjs  Cotton,  A.M.,  M.D.,  Professor  of  Orthopedic  Surgery  and  Roent- 
genology. 

Andrew  C.  Gillis,  A.M.,  M.D.,  Professor  of  Neurology  and  Clinical 
Phychiatry. 

Joseph  H.  Branham,  M.D.,  Professor  of  Clinical  Surgery- 

Bernard  Purcell  Muse,  M.D.,  Professor  of  Clinical  Obstetrics. 

Charles  L.  Summers,  M.D.,  Professor  of  Pediatrics. 

Anton  G.  Rytina,  A.B.,  M.D.,  Professor  of  Genito-Urinary  Diseases. 

Henky'  J.  Walton,  M.D.,  Professor  of  Roentgenology. 

Maurice  C.  Pincoffs,  S.B.,  M.D.,  Professor  of  Medicine. 

R.  M.  Chapman,  M.D.,  Professor  of  Psychiatry. 

Nathan  Winslovt,  A.M.,  M.D.,  Cinical  Professor  of  Surgery. 

Page  Edmunds,  M.D.,  Clinical  Professor  of  Industrial  Surgery. 

Walter  D.  Wise,  M.D.,  Clinical  Professor  of  Surgery. 

Edgar  B.  Friedenwald,  M.D.,  Clinical  Professor  of  Pediatrics. 

CoMPTON  RiELY,  M.D.,  Clinical  Professor  of  Orthopedic  Surgery. 

W.  S.  Smith,  M.D.,  Clinical  Professor  of  Gynecology. 

Joseph  W.  Holland,  M.D.,  Clinical  Professor  of  Surgery. 

E.  B.  Freeman,  B.S.,  M.D.,  Clinical  Professor  of  Gastro-Enterology. 

J.  C.  Lumpkin,  M.D.,  Clinical  Professor  of  Surgery. 

T.  Fred  Leitz,  M.D.,  Clinical  Professor  of  Gastro-Enterology. 

J.  W.  Downey'.  M.D.,  Clinical  Professor  of  Otology. 

Edward  A.  Loopek,  M.D.,  D.Oph.,  Clinical  Professor  of  Diseases  of  Nose 
and  Throat. 

Sydney  M.  Cone,  A.B.,  M.D.,  Associate  Professor  of  Pathology. 

Hugh  Brent,  M.D.,  Associate  Professor  of  Gynecology. 

Melvin  Rosenthal,  M.D.,  Associate  Professor  of  Dermatology. 

Hubert  C.  Knapp,  M.D.,  Associate  Professor  of  Medicine. 

Abraham  Samuels,  Ph.G.,  M.D.,  Associate  Professor  of  Gynecology. 

William  W.  Requabdt,  M.D.,  Associate  Professor  of  Surgery. 

George  W.  Mitchell,  M.D.,  Associate  Professor  of  Diseases  of  Throat  and 
Nose. 

Lewis  J.  Rosenthal,  M.D.,  Associate  Professor  of  Proctology. 

J.  R.  Abercrombie,  A.B.,  M.D.,  Associate  Professor  of  Dermatology. 

C.  C.  CoNSER.  M.D.,  Associate  Professor  of  Physiology. 

H.  J.  Maldeis,  M.D.,  Associate  Professor  of  Medical  Jurisprudence. 


e  BOARD  OF  INSTRUCTION 

J.  Dawson  Reeder,  M.D.,  Associate  Professor  of  Proctology. 

H.  C.  Blake,  M.D.,  Associate  Professor  of  Clinical  Surgery. 

Frank  S.  Lynn,  M.D.,  Associate  Professor  of  Surgery. 

G.  M.  Settle,  A.B.,  M.D.,   Associate  Professor  of  Neurology  and  Clinical 

Medicine. 
C.  C.  W.  JuDD,  A.B.,  M.D.,  Associate  Professor  of  Medicine. 
Elliott  H.  Hutchins,  A.B.,  M.D.,  Associate  Professor  of  Surgery 
Thomas  R.  Chambers,  A.B.,  M.D.,  Associate  Professor  of  Surgery. 
R,  W.  LocHER,  M.D.,  Associate  Profes.sor  of  Operative  and  Clinical  Surgery. 
H.  D.  McCarty,  M.D.,  Associate  Pi'ofessor  of  Clinical  Medicine. 
O.  Glenn  Harne,  A.B.,  Associate  Professor  of  Pharmacology. 
John  Evans,  M.D.,  Associate  Professor  of  Roentgenology. 
Clyde  A.  Clapp,  M.D.,  Associate  Professor  of  Ophthalmology. 
J.  F.  LuTZ,  A.B.,  M.D.,  Associate  Professor  of  Medicine. 

F.  W.  Hachtel,  M.D.,  Associate  Professor  of  Bacteriology. 
Wm.  J.  Carson,  M.D.,  Associate  Professor  of  Pathology. 
Wh,liam  H.  Smith.  M.D..  Associate  Professor  of  Clinical  Medicine. 
Paul  W.  Clough,  B.S.,  M.D.,  Associate  Professor  of  Medicine. 
Sidney  R.  Miller,  A.B.,  M.I).,  Associate  Professor  of  Medicine. 

Jj.  H.  Douglass,  M.D..  Associate  Professor  of  Obstetrics. 

M.  Randolph  Kahn,  M.D.,  Associate  Professor  of  Ophthalmology. 

S.  Lloyd  Johnson,  A.B.,  M.D.,  Assistant  Profes.sor  of  Medicine. 

E.  H.  Hayvs^ard,  M.D.,  Associate  in  Gynecology. 

R.  C.  Metzel,  M.D.,  Associate  in  Clinical  Medicine. 

John  E.  O'Neill,  M.D.,  Associate  in  Clinical  Medicine. 

Geo.  a.  Strauss,  Jr.,  M.D..  Associate  in  Gynecology. 

H.  K.  Fleck,  M.D.,  Associate  in  Ophthalmology. 

Joseph  I.  Kemler,  M.D.,  Associate  in  Ophthalmology. 

Henry  T.  Collenberg,  A.B.,  M.D.,  Associate  in  Clinical  Pathology. 

G.  F.  Sargent,  M.D.,  Associate  in  Clinical  Psychiatry. 

George  Murg.vtroyd,  M.D..  Associate  in  Diseases  of  the  Throat  and  Nose. 

J.  Harry  Ullrich,  M.D.,  Associate  in  Gastro-Enterology. 

J.  McF.  Bekgland,  M.D.,  Associate  in  Obstetrics. 

R.  G.  Willse,  M.D..  Associate  in  Gynecology. 

Sam'l  W.  Moore,  D.D.S.,  Associate  in  Anaesthesia. 

Frank  J.  Kirby,  M.D.,  Associate  in  Surgery. 

Harry  M.  Robinson,  M.D.,  Associate  in  Dermatology. 

Theodore  Morrison,  M.I)..  Associate  in  Gastro-Enterology. 

W.  F.  ZiNN,  M.D..  Associate  in  Diseases  of  the  Nose  and  Throat. 

W.  I.  Messick,  M.D..  Associate  in  Clinical  Medicine. 

E.  A.  Knorr,  M.D.,  Associate  in  Ophthalmology. 

Harold  E.  Wright,  INI.D..  Associate  in  Physiology. 

L.  A.  M.  Krause,  M.D.,  Associate  in  Medicine. 

C.  L.  JosLiN,  M.D.,  Associate  in  Pediatrics. 

Harry  M.  Stein.  M.D.,  Associate  in  Medicine. 

George  McLean,  M.D.,  Associate  in  Medicine. 


BOARD  OF  INSTRUCTION  9 

Paul  J.  Ewerhardt,  M.D.,  Associate  iu  Psychiatry. 
George  E.  Clarke,  M.D.,  Associate  in  Psychiatry. 
H.  S.  Gorsuch,  M.D.,  Associate  iu  Obstetrics. 
W.  H.  TouLsoN,  Associate  in  Urology. 

C.  Eeid  Edwards,  M.D.,  Associate  iu  Surgery  and  Radio-therapy. 
M.  J.  Hanna,  M.D.,  Associate  iu  Anatomy. 

W.  H,  Daniels,  M.D.,  Demonstrator  of  Orthopedic  Surgery. 
W.  Arthur  Darby,  M.D.,  Demonstrator  of  Orthopedic  Surgery. 
R.  L.  Mitchell,  M.D.,  Instructor  in  Gynecology. 
Benjamin  Pushkin,  M.D.,  Instructor  in  Neurology. 
F.  L.  Jennings,  M.D.,  Instructor  in  Surgery. 
E.  E.  Mayer,  M.D.,  Instructor  in  Medicine. 
W.  G.  Queen,  M.D.,  Instructor  in  Anaesthesia. 
Harris  Goldman,  M.D.,  Instructor  in  Urology. 

D.  CoRBiN  Streett,  M.D.,  Instructor  in  Medicine. 

A,  M.  Evans,  M.D.,  Instructor  in  Surgery. 

C.  C.  Habliston,  M.D.,  Instructor  in  Medicine. 
Maurice  Feldman,  M.D.,  Instructor  in  Gastro-Enterology. 
Frank  N.  Ogden,  M.D.,  Instructor  iu  Biological  Chemistry. 
Martin  Sloan,  M.D.,  Instructor  in  Medicine. 

E.  S.  Johnson,  M.D.,  Instructor  in  Surgery. 
H.  M.  Foster,  M.D.,  Instructor  in  Surgery. 

FiBMADGE  K.  Nichols,  A.B.,  M.D.,  Instructor  in  Physiology. 

MiLFORD  Levy,  M.D.,  Instructor  iu  Neurology. 

Frank  B.  Anderson,  M.D..  Instructor  in  Diseases  of  the  Throat  and  Nose. 

W.  H.  Ingram,  M.D.,  Instructor  in  Pediatrics. 

H.  R.  LicKLE,  M.D.,  Instructor  iu  Medicine. 

J.  W.  Martindale,  M.D..  Instructor  in  Medicine. 

Charles  R.  Goldsborough,  A.M.,  M.D.,  Instructor  in  Medicine. 

Louis  F.  Krumrein,  M.D.,  Instructor  in  Bacteriology. 

Henry  F.  Buettner,  M.D.,  Instructor  in  Bacteriology. 

J.  A.  F.  Pfeiffer,  M.D.,  Instructor  in  Bacteriology. 

Joseph  E.  Gately,  M.D..  Instructor  in  Dermatology. 

E.  P.  Smith,  M.D.,  Assistant  in  Operative  Surgery. 
J.  A.  Skladowsky,  M.D.,  Assistant  in  Neurology. 
John  Houff,  M.D.,  Assistant  iu  Pediatrics. 

F.  K.  Kearney,  M.D.,  Assistant  in  Surgery. 
T.  K.  Galvin,  M.D.,  Assistant  in  Gynecology. 

G.  W.  Bowden,  M.D.,  Assistant  in  Surgery. 
F.  H.  Machin.  M.D.,  Assistant  in  Obstetrics. 
Horace  Byers,  M.D.,  Assistant  in  Medicine. 
DwiGHT  MoHR,  M.D.,  Assistant  in  Surgery. 

J.  G.  M.  Reese,  M.D.,  Assistant  in  Obstetrics. 
Amos  Hutchins,  M.D.,  Assistant  in  Surgery. 

B.  J.  Ferry,  M.D.,  Assistant  in  Pediatrics. 
H.  H.  Warner,  M.D.,  Assistant  in  Pediatrics. 


10  UNIVERSITY  HOSPITAL,  STAFF 

J.  F.  Hawkins,  M.D.,  Assistant  in  Pediatrics. 
Joseph  Sindler,  M.D.,  Assistant  in  Gastro-Enterology. 
C.  A.  Reifschneidee,  M.D.,  Assistant  in  Surgery. 
W.  R.  Gekathy,  M.D.,  Assistant  in  Surgery. 
S.  Demarco,  M.D..  Assistant  in  Surgery. 
Jack  M.  Hundley,  M.D.,  Assistant  in  Surgery. 

0.  H.  Lloyd,  M.D.,  Assistant  in  Surgery. 
Clyde  N.  Marvel,  M.D.,  Assistant  in  Surgery. 
E^-ERARD  Briscoe,  M.D.,  Assistant  in  Surgery. 
W.  J.  ToDD,  M.D.,  Assistant  in  Pediatrics. 

Percy  B.  Hardcastle,  M.D.,  Assistant  in  Pediatrics. 

John  H.  Traband,  M.D.,  Assistant  in  Pediatrics. 

SusANNE  Parsons.  A.B.,  M.D..  Ph.D.,  Assistant  in  Obstetrics. 

L.  K.  Fargo,  M.D.,  Assistant  in  Genito-Urinary  Diseases. 

M.  Chideckel,  M.D.,  Assistant  in  Gastro-Enterology. 

N.  J.  Davidov,  M.D.,  Assistant  in  Gastro-Enterology. 

Albert  Eisenbekg,  M.D.,  Assistant  in  Gastro-Enterology. 

M.  Koppelman,  M.D.,  Assistant  in  Gastro-Enterology. 

Zacariah  Morgan,  M.D.,  Assistant  in  Gastro-Enterology. 

Paul  Foreman  Wiest,  M.D.,  Assistant  in  Gastro-Enterology. 

William  F.  Geyer,  M.D.,  Assistant  in  Pediatrics. 

George  E.  Wells,  M.D.,  Assistant  in  Pediatrics. 

F.  B.  Smith,  M.D.,  Assistant  in  Pediatrics. 

P.  Aetigiani,  M.D.,  Assistant  in  Pediatrics. 

1.  J.  Feingart,  M.D.,  Assistant  in  Pediatrics. 
E.  D.  Weinberg,  M.D.,  Assistant  in  Pathology. 

A.  E.  Goldstein,  M.D.,  Assistant  in  Pattiology. 

Dudley  Pleasants  Bowk,  B.A.,  M.D.,  Assistant  in  Obstetrics. 

R.  F.  McKenzie,  M.D..  Assistant  in  Diseases  of  the  Throat  and  Nose. 

Stanley  E.  Matthews,  M.D.,  Assistant  in  Obstetrics, 

Wetheebee  Fort,  M.D.,  Assistant  in  Medicine. 

B.  B.  Brumbaugh,  M.D.,  Assistant  in  Medicine. 
Herman  Seidel.  M.D.,  Assistant  in  Medicine. 


UNIVERSITY  HOSPITAL  STAFF. 

Superintendent  of  the  Hospital,  Kenneth  B.  Jones,  M.D. 

Physicians. 

Gordon  Wilson,  M.D.  Maurice  C.  Pincoffs.  M.D. 

Charles  W.  McElfresh,  M.D.  G.  Carroll  Lockard,  M.D., 

RoscoE  C.  Metzel,  M.D.  «  Jos.  E.  Gichner,  M.D. 

Paul  W.  Clougii,  M.D.  Wm.  H.  Smith,  M.D. 

Oastro  Enterologists. 
Julius  Friedenwald,  A.M..  M.D.  John  C.  Hemmeter,  Ph.D.,  M.D. 


UNIVERSITY  HOSPITAL  STAFF  11 

Neurologist. 
Ikving  J.  Speak,  M.D. 

Psychiatrist. 
R.  M.  Chapman,  M.D. 

Pediatrician. 
Charles  L.  Summers,  M.D. 

Pathologists. 
Hugh  B.  Spenctee,  M.D.  Standish  McCleaby,  M.D. 

S.  Lloyd  Johnson,  M.D. 

Surgeons. 
Randolph  Winslow,  A.M.,  M.D.,  LL.D.  Arthur  M.  Shipley,  M.D. 

Joseph  W.  Holland,  M.D.  Page  Edmunds,  M.D. 

Nathan  Winslow,  A.M.,  M.D.  Frank  S.  Lynn,  M.D. 

Charies  Reid  Edwards,  M.D. 

Laryngologist. 
Edward  A.  Loopeb,  M.D. 

Proctologists. 
G.  Milton  Linthicum,  A.M.,  M.D.  J.  Dawson  Reedeb,  M.D. 

Orthopedic  Surgeons. 
R.  Tunstall  Taylor,  A.B.,  M.D.  Compton  Riely,  M.D. 

Genito-Urinary  Surgeons. 
Page  Edmunds,  M.D.  W.  H.  Toulson,  M.S.,  M.D. 

Roentgenologist. 
Henry  J.  Walton,  M.D. 

Dermatologist. 
Harry  M.  Robinson,  M.D. 

Obstetricians. 
L.  E.  Neale,  M.D.  J.  M.  H.  Rowland,  M.D. 

L.  H.  Douglas,  M.D.  J.  G.  M.  Reese,  M.D. 

Ophthalmologists  and  Otologists. 

Harry  Friedenwald,  M.D. 

William  Tarun,  M.D.  Hiram  Woods,  A.M.,  M.D. 


12 


UNIVERSITY  HOSPITAL  EISPENSARY  STAFF 


J.  Mason  Hundley,  M.D. 
Hugh  Bbent,  M.D. 


Oynecologists. 


W.  S.  Gardner,  M.D. 
R.  G.  WiLLSE,  M.D. 


RESIDENT  STAFF. 
Resident  Physician. 
Leon  Freedom,  M.D. 

Resident  Burgeon. 
L.  H.  Brumback,  M.D. 

Resident  Gynecologist. 
Earle  E.  Broadrup,  M.D. 

Resident  Obstetrician. 
J.  Morris  Reese,  M.D. 

Resident  Pathologist. 
W.  HoRSLEY  Gantt,  M.D. 


Resident  Pediatrician, 
John  F.  Aubrey,  M.D. 


Internes. 
C.  F.  Fisher,  M.D. 

J.  W.   GUYTON,  M.D. 
T.  N.  Wilson,  M.D. 
J.  R.  Kemp,  M.D. 
Thomas  R.  O'Rourke,  M.D. 
William  Huff,  M.D. 

William  Fulton,  M.D 


Ira  p.  Champe.  M.D. 
G.  C.  Halley,  M.D. 
A.  Y.  Buchness,  M.D. 
M.  C.  Lang,  M.D 
William  Hollister,  M.D. 
Bricey  M.  Rhodes,  M.I>. 


UNIVERSITY  HOSPITAL  DISPENSARY  STAFF. 

Medicine. 
H.  M.  Stein,  M.D.,  Chief  of  Clinic. 
Horace  Byers,  M.D.  G.  L.  Zimmerman,  M.D. 

C.  R.  Goldsborough,  M.D.  B.  B.  Brumbaugh.  M.D 

S.  R.  Clarke,  M.D.  L.  L.  Gordy.  M.D. 

W.  G.  Clopton,  M.D. 


UNIVEESITY    HOSPITAL    DISPENSAEY    STAFF  13 

Diseases  of  Stomach  and  Intestine. 
J.  H.  Ullrich,  M.D.,  Chief  of  Clinic. 
Joseph  Sindler,  M.D.  M.  S.  Koppelman,  INl^D. 

Z.  Morgan,  M.D.  N.  J,  Davidov,  M.D. 

Paul  F.  Wiest,  M.D.  W.  H.  Gantt,  M.D. 

Pediatrics. 

Charles  L.  Summers,  M.D..  Professor  of  Pediatrics. 

C.  L.  Joslin,  M.D.,  Chief  of  Clinic. 

B.  J.  Ferry,  M.D.  F.  B.  Smith,  M.D. 
John  Houff,  M.D.                                                     P.  Artigiani,  M.D. 
W.  H.  Ingram,  M.D.                                                  R.  S.  Kirk,  M.D. 
John  H.  Traband,  M.D.                                            J.  F.  Hawkins,  M.D. 
W.  G.  Geyer,  M.D.                                                     Wm.  G.  Todd,  M.D. 
George  E.  Wells,  M.D.                                            H.  H.  Warner,  M.D. 

C.  R.  Goldsborough,  M.D. 

Netirology. 

Irving  J.  Speak,  M.D.,  Professor  «f  Neurology. 

G.  M.  Settle,  M.D.,  Chief  of  Clinic. 

J.  A.  Skladowsky,  M.D.  B.  Pushkin,  M.D. 

Psychiatry. 

R.  M.  Chapman.  M.D.,  Professor  of  Psychiatry. 

Paul  J.  Ewerhardt,  M.D.  George  E.  Clarke,  M.D. 

Tuherctilosis. 

J.  E.  O'Neill,  M.D.,  Consultant. 

C.  C.  Habliston,  M.D.,  Chief  of  Clinic. 

Surgery. 
Charles  Reid  Edwards,  M.D.,  Chief  of  Clinic. 
H.  M.  Foster,  M.D.  E.  S.  Johnson,  M.D. 

C.  A.  Reifschneider,  M.D.  D.  E.  Fay,  M.D. 

E.  S.  Perkins,  M.D.  W.  R.  Johnson,  M.D. 

W.  K.  Harryman,  M.D.  James  Brown,  M.D. 

C.  F.  HoRiNE,  M.D. 

Orthopedics. 

R.  TuNSTALL  Taylor,  A.B.,  M.D.,  Professor  of  Orthopedic  Surgery. 

Compton  Riely,  M.D.,  Chief  of  Clinic. 

W.  H.  Daniels,  M.D.  H.  L.  Wheeler,  M.D. 

W.  H.  Darby,  M.D. 


14  MERCY  HOSPITAL  STAFF. 

Oenito-Urinary. 

W.  H.  TouLsoN,  M.D.,  Chief  of  Clinic. 

AusTiJf  H.  Wood,  M.D.  Amos  F.  Hutchins,  M.D. 

X-Ray. 

Henry  J.  Wai^ton.  M.D.,  Roentgenologist. 

Miss  Sue  W.  Shriveb,  Technician. 

Dermatology. 

H.  M.  Robinson,  M.D.,  Chief  of  Clinic. 

J.  E.  Gately,  M.D.  J.  A.  Buchness,  M.D. 

Gynecology. 
R.  G.  WiLLSE,  M.D.,  Chief  of  Clinic. 
G.  A.  Strauss,  M.D.  T.  K.  Galvin,  M.D. 

J.  M.  Hundley,  Jr.,  M.D.  Nathan  Winslow,  M.D. 

Leo  Brady,  M.D. 

Obstetrics. 
Li.  H.  Douglass,  M.D.,  Chief  of  Clinic. 
F.  H.  Machin,  M.D.  J.  G.  M.  Reese,  M.D. 

J.  W.  Ebebt,  M.D.  Dudley  Pleasants  Bowe,  B.A.,  M.D. 

Stanley  G.  Matthews,  M.D, 

Eye  and  Ear. 

Harry  Friedenwald,  M.D.,  Professor  of  Ophthalmology  and  Otology. 

J.  W.  Downey,  M.D, 

H.  L.  SiNSKY,  M.D.,  Chief  of  Clinic. 

Nose  and  Throat. 

E.  A.  LooPER,  M.D.,  Clinical  Professor  of  Diseases  of  Throat  and  Nose. 

Frank  B.  Anderson,  Chief  of  Clinic. 

George  Murgatroyd,  M.D.  Charles  J.  Norton,  M.D. 

H.  R.  LicKLE,  M.D. 

Social  Service. 
Miss  Grace  Pearson,  Directress. 


MERCY  HOSPITAL  STAFF. 

SURGICAL  DIVISION. 

Archibald  C.  Harrison,  M.D.  Alexius  McGlannan,  M.D. 

C.  F.  Blake,  M.D.  W.  D.  Wise,  M.D. 


MERCY  HOSPITAL   STAFF.  lO 

Associate  Surgeons. 
Elliott  H.  Hutchins,  M.D.  Harvey  B.  Stone,  M.D. 

R.  H.  LocHEB,  M.D.  A.  M.  Evans,  M.D. 

Thomas  R.  Chambers,  M.D.  William  W.  Requardt,  M.D. 

F.  L.  Jennings,  M.D. 

Assistant  Surgeons. 
Amos  Hutchins,  M.D.  F.  X.  Kearney,  M.D. 

I.  O.  RirGELY,  M.D.  Chas.  Maxon,  M.D 

N.  C.  Marvel,  M.D.  H.  B.  McElwain,  M.D. 

EvERARD  Briscoe,  M.D. 

Ophthalmologist  and  Otologist. 
Harry  Friedenwald,  M.D. 

Associates. 
H.  K.  Fleck,  M.D.  J.  W.  Downey,  M.D. 

RMnologists  and  Laryngologists. 
Frank  D.  Sanger,  M.D.  George  W.  Mitchell,  M.D. 

Associate  RMnologists  and  Laryngologists. 
W.  F.  Zinn,  M.D.  Raymond  McKenzie,  M.D, 

Proctologist. 
Charles  F.  Blake,  M.D. 

Assistant. 
L.  J.  Rosenthal.  M.D. 

Orthopedic  Surgeon. 
Albertus  Cotton,  M.D. 

Associate. 
H.  L.  Rogers.  M.D. 

Urologist. 
A.  G.  Rytina,  M.D. 

Assistant. 
A.  J.  GiLLis,  M.D. 


MEDICAL  DIVISION. 

Physicians. 
William  F.  Lockwood,  M.D.  Gary  B.  Gamble,  M.D 

Standish  McCleary,  M.D.  H.  G.  Beck.  M.D. 


16  MEECY   HOSPITAL  STAFF 

Associates. 
HuBEBT  C.  Knapp,  M.D.  E.  E.  Mayer.  M.D. 

C.  C.  W.  JuDD,  M.D,  Baetus  P.  Baggott,  M.D. 

Mabtin  F.  Sloan,  M.D.  G.  McLean,  M.D. 

J.  W.  Maetindale,  M.D. 

Oastro-Enterologists. 
Julius  Friedenwald,  M.D. 

Associates. 
T.  Fbedebick  Leitz,  M.D.  Theodobe  Mobbison,  M.D. 

Assistants. 
Maubice  Peldman,  M.D.  Joseph  Sindler,  M.D. 

Pediatrists. 
John  Kuhrah,  M.D.  Edgab  B.  Friedenwald,  M.D. 

Associate. 
Habey  Goldberg,  M.D. 

Neurologist  and  Psychiatrist. 
Andrew  C.  Gillis,  M.D. 

Assistants. 
L.  A.  M.  Kbause,  M.D.  Milfobd  Levy,  M.D. 

Dermatologist. 
Melvin  Rosenthal,  M.D. 


OBSTETRICAL  DIVISION. 

Obstetricians. 
Geo.  W.  Dobbin,  M.D.  Chables  E.  Brack,  M.D. 

Associate  Obstetricians. 
E.  P.  Smith,  M.D.  T.  K.  Galvin,  M.D. 


GYNECOLOGICAL  DIVISION. 

Qynecologists. 

William  S.  Gardner,  M.D  Abraham  Samuels,  M.D. 

George  A.  Strauss,  M.D. 


MEECY  HOSPITAL  DISPENSARY  STAFF  17 

Associate  Gynecologists. 
T.  K.  Galvin,  M.D.  E.  P,  Smith,  M.D. 


PATHOLOGICAL  DIVISION. 

Pathologist. 

Standish  McCleary,  M.D. 

Clinical  Pathologist. 

H.  T.  COLLENBERG,  M.D. 

Technicians — Sister  M.  Joan,  Ph.G.,  R.N.,  Adelia  Kelly,  R.N. 


DEPARTMENT  OF  DENTISTRY. 

Attending  Dentist. 

NoRVAL  McDonald,  D.D.S. 


X-RAY  DEPARTMENT. 

Radiographers. 

Albertus  Cotton,  M.D.  Harry  L.  Rogers,  M.D. 

MERCY  HOSPITAL— RESIDENT  STAFF. 
D.  J.  Pessagno,  M.D.,  Chief  Resident. 
C.  F.  Foley,  M.D.  Rayjxoxd  Peters,  M.D. 

J.  E.  KOPLOWITZ,  M.D.        "  K.  W.  Golley.  M.D. 

C.  G.  McCoy,  M.D.  Oscar  G.  Costa,  M.D. 

A.  R.  Saporito,  M.D.  Thos  Pereiba,  M.D. 

E.  Martinez,  M.D. 


DISPENSARY  STAFF  OF  MERCY  HOSPITAL. 

Surgery. 

Supervisors. 
Alexius  McGlannan,  M.D.  W.  D.  Wise,  M.D, 

Attending  Surgeons. 
A.  M.  Evans,  M.D.  O.  H.  Lloyd,  M.D. 

D.  H.  MoHR,  M.D.  Clyde  Marvel,  M.D. 

F.  X.  Kearney,  M.D.  A.  F.  Hutciiins.  M.D. 

I.  O.  Ridgely,  M.D.  Everard  Briscoe,  M.D. 

H.  B.  McElwain,  M.D. 


18  MEECY  nOSPITAL  DISPENSARY  STAFF 

Genito  Urinary  Surgery. 
Supervisor,  A.  G.  Rytina,  M.D. 

Attending  Surgeons. 
A.  L.  TUMBLESON,  M.D.  H.  C.  Knapp,  M.D. 

Habris  Goldman,  M.D.  A.  J.  Gillis,  M.D. 

J.  F.  HoGAN,  M.D. 

Orthopedic  Surgery. 
Albebtus  Cotton,  M.D.  Hakry  L.  Rogess,  M.D. 

Medicine. 
Supervisor,  Wm.  F.   Lockwood.   M.D. 

Attending  Physicians. 
Martin  F.  Sloan,  M.D.  R.  T.  Baggott,  M.D. 

Herman  Seidel,  M.D.  L.  A.  M.  Krause,  M.D. 

Wetherbee  Fort,  M.D.  Edward  Novak,  M.D. 

Diseases  of  Stomach. 
Supervisor,  Julius  Friedenwald,  M.D. 

Attending  Physicians. 
T.  Fbedebick  Leitz,  M.D.  Joseph  Sindler,  M.D. 

Theodore  H.  Morrison,  M.D.  M.  Chideckel.  M.D. 

M.  Feldman.  M.D.  S.  Zinberg,  M.D. 

A.  Eisenberg,  M.D. 

Nervous  Diseases. 
Superinsor,  A.  C.  Gillis. 

Attending  Physicians. 
Mn,FORD  Levy,  M.D.  Geo.  F.  Sargeant,  M.D. 

Diseases  of  Women. 

Supervisors. 
W.  S.  Gardner,  M.D.  A.  Samuels,  M.D. 

Attending  Surgeons. 
E.  P.  Smith,  M.D.  H.  Palmisiano,  M.D. 

T.  K.  Galvin,  M.D.  C.  F.  J.  Coughlin,  3f.D. 

Diseases  of  Xose  and  Throat. 
W.  F.  ZiNN,  M.D.  R.  F.  McKenzie,  M.D. 


kerna:^'  hospital  staff  19 

Diseases  of  Ej/e  and  Ear. 
H.  K.  Fleck,  M.D.  M.  Raskin,  M.D. 

Pediatrics. 
Edgar  B.  Friedenwald,  M.D. 
I.  J.  Feingart,  M.D.  M.  Ephraim.  M.D. 

M.  Cumin,  M.D. 

Neiiro-Otoloffu. 
J.  W.  Downey,  Jr.,  M.D. 

Proctology. 
L.  J.  Rosenthal.  M.D. 

Dermatology. 
Melvin  Rosenthal,  M.D. 

Dental  Clinic. 
NoRVAL  McDonald,  D.D.S.  L.  A.  Walzak,  D.D.S. 

Social  Service  Department. 
Katherine  a.  Monahan,  R.N.,  Director. 
Catherine  Campbell.  R.N.,  Assistant. 
Claea  E.  Connery,  R.N.,  Chief  Dispensary  Nurse. 
Helen  M.  Moore. 
Isabelle  Bruton,  Register. 

D  is  pens  a  ry  D  irect  ress. 
Sister  M.  Helen,  R.N. 


THE  JAMES  LAWRENCE  KERNAN  HOSPITAL  AND  INDUSTRIAL 
SCHOOL  OF  MARYLAND  FOR  CRIPPLED  CHILDREN. 

R.  TuNSTALL  Taylor,  A.B..  M.D.,  Surgeon-in-Chief. 

Associate  Surgeons. 

Sydney'  M.  Cone,  A.B.,  M.D.  Albertus  Cotton,  A.M.,  M.D. 

CoMPTON  Riely,  M.D. 

Attending  and  Dispensary  Surgeons. 

W.  H.  Daniels.  M.D.  J.  Albert  Key,  B.A..  M.D. 

E.  Lewis  Ardman,  B.A..  M.D. 


20  KBENAN  HOSPITAL  STAFF 

Instructors  in  Corrective  Gymnastics. 
Miss  Anita  Renshaw  Pbesstman.  Miss  Elizabeth  Emoby, 

Miss  Mary  H.  Lee,  Principal  0/  School. 

Kindergartner  and  Industrial  Teacher. 
(To  be  appointed.) 

Roentgenologists. 
Henry  J.  Walton,  M.D.  J.  F.  Lutz,  M.D. 

Attending  Plastic  Surgeon. 
John  Staige  Davis,  B.Sc,  M.D. 

Attending  Physician. 
Benjamin  Tappan,  B.A.,  M.D. 

Attending  Burgeon. 
A.  M.  Shipley,  M.D. 

Attending  Neuro  Surgeon. 
Charles  Bagley,  Jr.,  M.D, 

Attending  Laryngolist. 
F.  B.  Anderson,  M.D. 

Attending  Dermatologist. 
John  R.  Abercrombie,  A.B.,  M.D. 

Attending  Pathologist. 
Howard  J.  Maldeis,  M.D. 

Attending   Urologist. 
Gideon  Timberlake,  M.D. 

Attending  Oculist  and  Aurist. 
William  Tarun,  M.D. 

Attending  Neurologist. 
Irving  J.  Spear,  M.D. 

Attending  Dentists. 
G.  E.  P.  Truitt,  D.D.S.  J.  B.  Bell,  D.D.S. 


> 


BAYVIEW   HOSPITAL,   STAFF  21 

Consulting  Surgeons. 
W,  S.  Halstead,  A.B.,  LL.D.,  B.Sc,  M.D.        J.  M.  T.  Finney,  A.B.,  M.D. 
Randolph  Winslow,  A.M.,  M.D.,  LL.D.  Archibald  C.  Harrison,  M.D. 

Consulting  Physicians. 
Thomas  R.  Brown,  A.B.,  M.D.  Llewellys  F.  Barker,  A.B.,  M.D. 

Thomas  B,  Futcher,  A.B.,  M.D.  William  S.  Thayer,  A.B.,  M.D. 

Consulting  Oculist. 
Hiram  Woods,  M.D. 

Consulting  Laryngoloist. 
John  N.  Mackenzie,  A.B.,  M.D. 

Dispensary  and  Social  Service  Nurse. 
Miss  Mabel  Brown,  R,N. 

Head  IS'urse. 
Miss  Ida  Lachley,  R.N, 


STAFF  OF  THE  CITY  HOSPITALS  AT  BATTIEW. 

Thomas  R.  Boggs,  S.B.,  M.D.,  Physician-in-CMef. 

Abthub  M.  Shipley,  M.D.,  Surgeon-in-CMef. 

H.  D.  McCarty,  M.D.,  Physician-in-CMef  to   the  Municipal  Tuberculosis 

Hospital. 

Harry    Goldsmith,    M.D.,    Physician-in-Charge    of    the    City    Detention 

Hospital  for  the  Insane. 

John  R.  Cash,  M.D.,  Pathologist. 

Lawrence  Getz,  M.D.,  Acting  Pathologist  in  the  Absence  of  Dr.  Cash. 


CONSULTING  STAFF. 

Ophthalmologist. 
James  J.  Mills,  M.D. 

Otologist. 
William  Tabun,  M.D. 

Gynecologist. 
R.  G.  WiLLSE,  M.D. 


22  ~  BAYVIEW   HOSPITAL  STAFF 

Urologist. 
W.  H.  TouLSON,  M.D. 

Largynologists. 

Frank  Dyer  Sanger,  M.D. 

H.  R.  Slack,  M.D. 

Pediatrician. 
John  Ruhrah,  M.D. 

Isieurologist. 
Henry  M.  Thomas,  M.D. 

Psychiatrists. 
Henry  J.  Berkeley,  M.D. 
Adolph  Meyer,  M.D. 

Assistant  Visiting  Physician. 
Charles  R.  Austrian.  M.D. 

Assistant   Visiting  Surgeon. 
Frank  S.  Lynn,  M.D. 


STAFF  OF  NURSERY  AND  CHILD'S  HOSPITAL. 

At  ten  ding  Physicians. 
Edgar  B.  Friedenwald.  M.D.  .       Israel  Feinglos,  M.D. 

Surgeons. 
Thomas  R.  Chambers,  M.D.  F.  L.  Jennings,  M.D. 

OpthahnologiKt  and  Otologist. 
Harry  Friedenwald,  M.D. 

Laryngologist  and  Rhinologist. 
M.  L.  Breitstein,  M.D. 

Orthopedist. 
William  Nachlas,  M.D. 

Interne. 
Frederick  Dart. 


STAFF   or   NURSERY  AND  CHILd's   HOSPITAL  23 

Superintendent. 
Miss  George  Allen  Hutton. 

Assistant  Superintendent. 
Miss  Margaret  Collison. 


ST.  VINCENT'S  INFANT  ASYLUM. 

Visiting  Physicians. 
Chaeles  O'Donovan,  A.M.,  M.D.  Chables  P.  Clautice,  M.D. 

Charles  L.  Summers,  M.D.  Charles  R.  Goldsborough,  M.D. 

T.  F.  White,  M.D. 

Visiting  Surgeon. 
Alexius  McGlannan,  M.D. 

Visiting  Oculists  and  Aurists. 
J.  Frank  Crouch,  M.D.  Clyde  A.  Clapp,  M.D. 

Visiting  Orthopedic  Surgeon. 
CoMPTON  Reilly,  M.D. 

Visiting  Proctologist. 
G.  Milton  Linthicum,  A.M.,  M.D. 

Pathologist. 
Sydney  M.  Cone,  A.M.,  M.D. 


MATRICULATES,   UNIVERSITY   OF    MARY- 
LAND SCHOOL  OF  MEDICINE  AND  COL- 
LEGE OF  PHYSICIANS  AND  SURGEONS, 
1921-1922. 


POST-GRADUATES  AND  SPECIAL  STUDENTS. 


Name  State 

Barnes,  Harry  A.,  M.D Maryland 

Benson,    Frank   L.,   M.D Pennsylvania 

Bowers,   Ralph  C,   M.D Maryland 

Burton,    Frank   J.,    M.D Utah 

Cahn,    Charles  A.,   M.D.,   D.D.S.   Maryland 
deCaesar,    Domtnick    Joseph.  ..  .New  York 

Cousins,   John  Andrew-  • Maryland 

Craig,    Branch,    M.D Texas 

Ens«r,   C.  B.,  M.D Marjiand 

Foxwell,    Raymond   K.,   M.   D --D.  C. 

Hawkins,  Vallie,  M.D Pennsylvania 

Holroyd,    Frank    F.,    M.D. .  .  West  Virginia 


Name  State 

King,    W.    P North  Carolina 

Krieger,   Emanual,    D.D.S..  ....  .Maryland 

Meintzberger,  Gilbert  Stephen.  .Maryland 
Moore,  Donald  Bain,  M.D. .  North  Carolina 
Norman,   John   Standing,   M.D., 

North  Carolina 

Patterson,   R.   D.,   M.D North  Carolina 

Preston,   D.   G.,   M.D Virginia 

Shepard,   Gertrude .Georgia 

Williams,  Timothy  Graham,  M.D., 

North  Carolina 


FOURTH  YEAR  CLASS. 


Name  State 

Bailey,    Harry,    A.B Connecticut 

Buchness,  Anthony  V.,  A.  B Maryland 

Champe,  Jr.,  Ira  Preston.  .  .West  Virginia 

Doshay,    Louis    Jacob,    A.B New  York 

Fleischmann,   Berthold,   B.   S. .  .  New  York 

Freidus,    Elias New   York 

Fritz,   Julius  Dudley New  York 

Fulton,   William  James Maryland 

Ginsberg,    William,    A.B New  York 

Ooldmann,  Bemhard  Alexander, 

Pennsylvania 

Gollick,  William  A.,  B.  S New  Jersey 

Gordon,    Elias,    B.S..  .••...  .Pennsylvania 

Gordon,    Herbert New   York 

Greenbaum,  Leonard  Harry Maryland 

Groff,   Morris New  York 

Halley,    George   Conrad Idaho 

Harman,  Robert  Dove,  B.S. .West  Virginia 

Hatfield,   Daniel  S West  Virginia 

Heitsch,    Hubert   M Michigan 

Hollister,  William,  B.  S. .  .  .  North  Carolina 
Horowitz,  Herman  Jack,  B.  S.,  New  York 

Huff,  William,   A.B Virginia 

Ingram,  David  N Maryland 

Keef e,  George  G.,  A.  B Connecticut 

Kerdasha,    George    S New  Jersey 

Krager,   John  J.,   A.B Maryland 

Kunkowski,  Andrew Maryland 

Lang,  Milton  Charles Maryland 

Lawson,  Lawrence  Wells,  A.B., 

West  Virginia 
Linke,  James  Julian  Paul,  B.  S., 

New  Jersey 


Name  State 

McCoy,  C.  Glen,  A.  B West  Virginia 

Mercier,  Albin  Scott,  A.  B Maryland 

Middlemiss,  Wm.  Robert,  B.  S Utah 

Monninger,    Arthur    Cecil.  .  ..Pennsylvania 

Morgan,  Edward  Nicholas New  York 

Noll,  Louis,   B.   S Connecticut 

O'Connor,  John  Andrew,  A.  B. .  .Maryland 
Payne,  John  Edward,  B.  S.,  West  Virginia 

Peters,  H.  Raymond,  B.  A Maryland 

Pittman,  Henry  Lee North  Carolina 

Pullen,    Guy  Foote Connecticut 

Rhodes,  Bricey  Milton Florida 

Rudisill,  John  David,   A.  B., 

North   Carolina 
Salzberg,    Abraham   Hellman.  .  ..New  York 

Saporito,  Archibald  R New  Jersey 

Sekerak,  Arthur  Joseph  Francis, 

Connecticut 

Shannon,   George  Edmon Maryland 

Shapin,    Sydney New  York 

Shapiro,   Louis  Mendelsohn,  B.  A., 

Connecticut 

Sternberg,    Harry   Melmuth New  York 

Stovin,  Joseph  Samuel,  Ph.  B.,  Connecticut 

Stout,  Philip  David,  B.  A Tennessee 

Sweet,  Samuel  Waterman,  B.   S., 

New  York 

Trynin,    Aaron   H.,    B.   A New   York 

Warfleld,  Jr.,  John  Ogle,  A.  B., 

Pennsylvania 
Wilson,  Thomas  Norwood,  A.  B.,  Maryland 


MATEICULATES    1921-1922 


25 


THIRD  YEAB  CLASS. 


Name  State 

Beck,   Nathaniel  M.,   A.   B Maryland 

Berkson,  Morris  I Pennsylvania 

Bowers,  Jr.,  Thaddeus  R.,  A.B., 

North  Carolina 
Clapbam,  Roger  E.,  B.S. .  ."West  Vir^cinia 
Cortese,   Anthony  Edward ....  New  Jersey 

Dart,    Frederick   Bond Connecticut 

Desane,  Joseph New  York 

Edmonds,  John  Milton Michigan 

Fleshman,  Dewey  Lynwood,  B.S., 

West  Virginia 

Goldberg,    Ben New   York 

Gordon,   Abraham    S New  York 

Giffin,  Theodore  Clifton,  B.S., 

West  Virginia 
Grose,   Robt.   Glenn,   B.A..  .North  Carolina 

Groves,    Robt.   B.,    B.A North  Carolina 

Gutowski,   Joseph  Matthew ...  New   Jersey 

Hagerman,   Paul West  Virginia 

Harp,   J.   Elmer Maryland 

Hirsch,   Philip New   York 

Hundley,  Jr.,  John  T.  T.,  A.  B. .  .  Virginia 
Hunt,  William  Bryce,  B.A.,  North  Carolina 
Jennette,  William  Carl,  A.B., 

North  Carolina 

Keith,  Marion  Yates North  Carolina 

Knipp,   George  A Maryland 

Kraut,  Arthur  Milton New  Jersey 

Kyper,  Frederick  T •  -Pennsylvania 

Lally,    Leo   Aloysius Pennsylvania 

Long,  Ira  C,  A.  B North  Carolina  ' 

Love,  Jr.,  William  Samuel,  B.A., 

Maryland 
McCuUough,  Carlton  S.  L.,  B.S., 

Pennsylvania 
McLean,  Herbert  E.,  B.A New  Jersey 


Name  State 

Moler,   Raleigh  M.,   B.S Wett  Virginia 

Murray,   Robert  Lebby,   B.S., 

North  Carolina 
Myers,    Karl   Johnson,    B.S.  .West  Virginia 

Newcomer,    David    R.,     B.S Maryland 

Newcomer,    Ward    E.,    B.S. ..  Pennsylvania 

Parson,  Willard  Sigsbee Pennsylvania 

Peterman,   James  Elmer Pennsylvania 

Pondfield,    Louis    F.,    B.A Maryland 

Pontery,  Herbert New  Jersey 

Povalski,  Alexander  WUliam .  .  New  Jersey 
Prather,    Fonzo   Goff,    B.S..  .West  Virginia 

Rothfuss,  Paul  A.,  B.   S Pennsylvania 

Ruche,    Harry   Charles Pennsylvania 

Saurborne,   Sylvia  M.  B.,   B.S., 

West  Virginia 

Schorr,  Richard New  York 

Shealy,  Walter  Hal,  B.  A. .  .  South  Carolina 

Sherman,    Louis     .  • New  York 

Smith,    Charles   Franklin.  ..  .Pennsylvania 

Snaith,     Theresa    Ora West  Virginia 

Sowers,  Roy  Gerald,  B.S.,  M.A.. 

North  Carolina 
Steincrohn,  Peter  Joseph.  ..  .Connecticut 
Sussman,  Abram  Allen,  D.D.S. .  .Maryland 

Touhey,  Thomas  Joseph Delaware 

Walker,  William  Wallace,  B.S., 

West  Virginia 

Wasserstrom,    Sidney New    York 

Weinert,   Henry  V New  Jersey 

Welton,  William  Archibald,  B.S., 

West  Virginia 

Werner,    Walter    I Ohio 

White,  Francis  Willard  Moody,  B.A., 

North  Carolina 
White,   James   Franklin,   B.S., 

West  Virginia 


SECOND  YEAR  CLASS. 


Name  State 

Allen,  Moore  Lowry Utah 

Anderson,   Albert  Louis Maryland 

Antonius,  Nicholas  A New  Jersey 

Barnes,    D.   Keith Utah 

Bartlett,   Jr.,   Charles  Wm Florida 

*Bershatsky,    William    ........  New  York 

Boyd,  Kenneth  Beay Maryland 

Briglia,    Nicholas   Natale. ..  .Pennsylvania 

Carter,  Carl  John West  Virginia 

Edelman,   Edward   Isidor New  York 

Fisher,  Harry  Richard New  York 

Flax,   Ira  Isador New  Jersey 

Frehling,    Joseph   Morris Kentucky 

Friedman,   Bernard New  York 

*Note — Not    in    attendance. 


Name  State 

Friedman,    Irving New    Jersey 

Gattens,  Wilber  Elton,  B.S Maryland 

**Gottlieb,    Bernard    Norman ...  New  Y'ork 

Granoff,  Joseph  F New  York 

Greifinger,  Marcus  Harry New  Jersey 

Grossblatt,   Philip New   Jersey 

Howell,  Clewell,  B.  S North  Carolina 

Jacobson,     Philip Maryland 

Knox,  Joseph  Clyde North  Carolina 

Koons,  Earle  Weant,  B.  S Maryland 

Kratz,    Fred    William Maryland 

Leibensperger,    George    F. .  .  .  Pennsylvania 

Levine,    Samuel New   Jersey 

Marsh,  James  T.,  A.  B Maryland 


26 


MATKICULATES    1921-1922 


SECOKD  YEAR  CLASS — Continued. 


Name 


State 


Marton,   Samuel New  York 

Maseritz,  Isidore Maryland 

Maurillo,    Dominick  Francis,   A.B., 

New  York 

Megahan,    Burke Pennsylvania 

Messinger,    Benjamin New   York 

Miller,  Benjamin Maryland 

MUler,  Jacob  M •  • Maryland 

Miller,   Joseph   G Maryland 

Monroe,    Clement    R. .  .  •  •  .  .North  Carolina 

Moriarty,    Louis Connecticut 

Morris,    Philip New   York 

Morrison,   Jr.,   William   Henry, 

Pennsylvania 
McLane,  William  Oliver,  Jr.,  B.S., 

Maryland 
McClosky,   William  Thomas, 

District  of  Columbia 

Nash,   Alexander  E New  Jersey 

Nelson,  James  Wharton,  A.  B. .  .  Maryland 
Neustaedter,  Theodore  M New  York 


Name 


State 


Nocera,    Domingo Porto   Rico 

Norment,  John  E.,  A.  B Maryland 

Pachtman,    Isadore Pennsylvania 

Perry,  Arch.  H North  Carolina 

Pitkowsky,    Louis  K New  York 

**Sarubin,    Benjamin    Maryland 

Scagnetti,    Albert New    York 

Scheindlinger,  Morris  I New  York 

Schlenger,   Leo  Brenner New  Jersey 

Schultz,  Louis  Ariel New  York 

Scimeca,   Antonio   Adolf o New   York 

Seliger,   Robert  V New  York 

Shapiro,  Ralph  N New  Jersey 

Tabershaw,   Arnold  Leon New  York 

Theuerkauf,    Frank   Joseph.  .Pennsylvania 

Urbanski,  Adrian  Xavier New  Jersey 

Weiner,    Hymen    L Pennsylvania 

Weinstock,   Alex.  A New  York 

Whaley,    Thomas   Bravard Maryland 

Woodyard,  Edwin  Sayre  ....  West  Virginia 
Zaslow,   John New  York 


FIRST   YEAR   CLASS. 


Balcerzak,    Stanley    Paul.  .  ..Pennsylvania 

*Brender,   Max    New  York 

Bentz,    Felix    .  .  ■  • Connecticut 

Brown,   Leo   T District  of  Columbia 

*Burke,    E.    N Kentucky 

Cadle,    William   Rodman Maryland 

Cantor,    Nathan    Connecticut 

*Callahan,   J.   J 

Carder,  Joe  R West  Virginia 

Cardinale,    P.    F New  Jersey 

*Casey,    Calvert   E Rhode  Island 

Cassidy,  John  J.,  B.S Delaware 

Clahr,   Abraham   Albert New  York 

Coonan,    Jr.,    Thos.   J.,    A.B Maryland 

Coe,    John   M Dist.  of  Columbia 

*Coff indaffer,    R.    S West  ViiKinia 

Cope,   Arthur   Alexander,   A.B., 

Pennsylvania 

Davis,    Norvel    R. .  .  •  • Maryland 

**Davidov,    Benjamin    Maryland 

**Davidson,    Meyer    Maryland 

Demely,    Louis   Alvin •  -Maryland 

De  Vinceutis,   Henry    New  Jersey 

**Diffenderffer,   Robert  Tinley, 

Pennsylvania 
Donohoe,  Edward  C,  A.B..  .  .Pennsylvania 
*Donovaai.  Charles  Michael.  .Connecticut 
Draper,  Leonidas  McFerren,  B.A., 

North  Carolina 

''Note — Not  in  attendance. 

**Note — Not   in    attendance    entire   session. 


Dreskin,   Jacob    L New  Jersey 

Dwyer,  D.  R.,  A.B ••....  Connecticut 

Elgin,    Lee    William Maryland 

Ellis,   Francis   A.,   A.B Maryland 

Epstein,    Harry    Herman New  York 

*Ehrenreich,   Isaac,    B.S Maryland 

Everett,    Franklin   A. .  .  •  •  .  .  .Pennsyls-ania 

Fancher,  Jr.,  H.  Wilson Connecticut 

Farber,    Raphael    Pennsylvania 

**Ferrara,  James    New  York 

Fields,    Abijah    Clements Alabama 

Fine,   Morris   Aaron .  .  •  • Maryland 

Finnell,    Reuben  Ashford Maryland 

Fischman,    Harold     New  Jersey 

Fishof ,   Frank New  York 

Fuchs,    Abner    •  •  New  York 

Gale,    Louis   Harry Pennsylvania 

Gaston,    William   Bryan West  Virginia 

**Geraghty,  Francis  J.,  B.A Maryland 

*Glickel,    Henry    New  York 

Grandfield,    Robert   Francis .  .  Rhode  Island 

*Greenwald,    M ••....  New  York 

Grimm,   Jr.,   Wilson  O West  Virginia 

Gross,    Sigmund    New  York 

**Hale,  Elwin  Faulconer Virginia 

Herbert,    Alpha    Nathan New  Jersey 

Hertz,    Ben •  •  New  York 

Hibbitts,    John    Thomas Maryland 

Hulla,   Jaroslav Maryland 


MATRICULATES    1921-1922 


27 


FIRST   YEAR   CLASS— Continued. 


Name  State 

Jacobs,    Morris    Albert Maryland 

Keating,    John   Patrick Connecticut 

**Kelly,   Allen   Wilbur -Maryland 

Kiesel,    Henry    New  York 

Knotts,    W.   K Maryland 

Lalley,    Paul   Francis Pennsylvania 

Ziaus,    Edward   Raymond New  York 

Iiinde,    S.    Arthur. Maryland 

London,   Daniel    New  York 

Lopatin,    Samuel     Connecticut 

Lowe,    Claude   Milton Pennsylvania 

Marciniak,    Edward    Stanley.  .  .New  Jersey 
Merchant,   Harry  McCreary,   B.S., 

Florida 

Metsky,    Joseph    .....  New  Jersey 

Miller,    Edgar   Raymond,    A.B., 

Pennsylvania 

Minnefor,    Chas.    A New  Jersey 

*Mitchell,   Charles  Archie,   A.B Maine 

Molina,    Rafael   Rodriguez Porto  Rico 

Morales,  Jaime  Vila Porto  Rico 

Mullenusky,    Joseph    John.  .  .Pennsylvania 

Nataro,  Joseph    New  Jersey 

Nimaroff,  Meyer    •  ■ New  Jersey 

Nock,    Randolph    Maxwell Maryland 

**Norment,    Clinton    Crawford.  .  Maryland 

Orton,    Lyman    R Massachusetts 

Oshrin,    Henry    New  Jersey 

Pearrell,    Ernest   H Maryland 

Pierce,    James    Lewis Florida 

Pinsky,    Myer    Mordecai New  Jersey 

Plassnig,    Edwin,     B.S Maryland 

Polizzotti,    Joseph    L New  Jersey 


Name  State 

Poplack,    Samuel   Lewis Connecticut 

Pulaski,    Leo    Edward Pennsylvania 

**Pullen,    Lawrence    Homer.  ..  .Maryland 

Radest,    Louis    ••....  New  York 

Rathsprecher,    Isadore    New  Jersey 

**Resh,     George    Daniel,    A.B..  .  Maryland 

**Rezck,    George  Jaroslav Maryland 

*Rosenberg,  H.  S New  York 

Rosenstein,   Jacob    New  York 

Rocco,  Frank    •  •  .  .  .  .New  Jersey 

Sarnoff,    Jack     Ne^^•  York 

Schachter,   Eugene  Joel Pennsylvania 

*Schilling,    A.    B New  Jersey 

Seiken,    George    New  York 

Silverstein,   Jacob  Maurice- •.  .New  Jersey 

Simon,   Joseph  R Pennsylvania 

**Smith,  Jr.,  James  Bathurst,  B.S., 

Virginia 

**Skilling,  Francis  C •  -Maryland 

Sinton,    William   Allen Virginia 

Straka,    Robert   Paul Pennsylvania 

Sulman,   William   R Pennsylvania 

*  Sweeney,    Jr.,   J.   J. .  .  ■  • Maryland 

Tomainoli,   M.    F New  Jersey 

Turner,     Thomas    Bourne,     B.S. .  Maryland 

Visconti,   Joseph  A New  Jersey 

Wallace,    Erwin   Basse Maryland 

Wasserweig,    Martin    Max.  .  .Pennsylvania 

Webb,   Elmore  Miller Maryland 

Wiener,    Joseph    ••....  New  York 

Weintraub,    Harry    Maryland 

**Wietzen,    Samuel New  York 

Zimmerman,    Charles    C Maryland 


■"Note — Not  in   attendance. 

''*Note — Not   in    attendance    entire    session. 


28 


GEADUATES   1921-1922 


GENERAL  SUMMARY  OF  STUDENTS  ATTENDING  THE  UNIVERSITY 
OF  MARYLAND,  SESSION  OF  1921-22. 

College  of  Home  Ecouoiuics I'i' 

College  of  Agriculture 190 

College  of  Eugiueeriug ■  •   164 

College  of  Arts  aud  Sciences 198 

College  of  Educatiou 72 

The  Graduate  Sctiool 23 

Tlie  Summer  School,  1921 3S0 

School  of  Medicine 299 

School  of  Law 490 

School  of  Deutistry 204 

School  of  Pharmacy 93 

School  of  Commerce 240 

School  of  Nurses 69 

Extension  Courses   75 

Total 2514. 


GRADUATES,  UNIVERSITY  OF  MARYLAND   SCHOOL  OF  MEDICINE 
AND  COLLEGE  OF  PHYSICIANS  AND  SURGEONS, 

JUNE    I,    1922. 


^'ame  State 

Bailey,     Harry,     B.A Connecticut 

Buchness,  Anthony  V.,   A.B.  •  •  .  .  Maryland 
Champa,    Jr.,    Ira   Preston.  .West  Virginia 

Doshey,    Louis    Jacob,    B.A Xew  York 

Fleischmann.   Berthold,   B.S Xew  York 

Freidus.   Blias Xew  York 

Fritz,    Julius    Dudley Xew  York 

Fulton,   William  James •  •  .  .  Maryland 

Ginsberg,    William,    B.A X'ew  York 

Goldmann,  Bemhard  Alexander, 

Pennsylvania 

Gollick,   WUliam  A.,   B.S Xew  Jersey 

Gordon,   Herbert    Xew  York 

Greenbaum,    Leonard    Harry.  ...  Maryland 

Groff,  Morris    ■  ■  Xew  York 

Hatfield,    Daniel    S West  Virginia 

Halley,  George  Conrad Idaho 

Harman,  Robert  Dove,  B.S.,  West  Virginia 

Heitsch,    Herbert   M •  •  Michigan 

Hollister,    William,    B.S.      .  Xorth  Carolina 
Horowitz,   Herman   Jack,    B.S.,   Xew   York 

Huff,    William,    B.A Virginia 

Ingram,    David    N Maryland 

Keefe,   George  G.,   A.B Connecticut 


Xame  State 

Eerdasha,    Geo •  •  Xew  Jersey 

Krager,   John  J.,   B.A Maryland 

Kunkowski,   Andrew    Maryland 

Lang,  Milton  Charles Maryland 

Lawson,  Lawrence  Wells,  B.A., 

West  Virginia 

Liuke,   Julian  P •  •  .  .  X'ew  Jersey 

McCoy,   C.  Glen,   A.B West  Virginia 

Mercier,   Albin   Scott,   A.B Maryland 

Middlemiss,    Wm.    Robert,    B.S Utah 

Monninger,    Arthur    C Pennsylvania 

Morgan,  Edward  Nicholas Xew  York 

O'Connor,   John   Andrew,    A.B.      Maryland 

Noll,    Louis,    B.S •  •  .  .  Connecticut 

Payne,    John   Edward,    B.S.  West  Virginia 

Peters,  H.  Raymond,  B.A Maryland 

Pittman,    Henry    Lee Xorth  Carolina 

Pullen,   Guy   Foote Conecticut 

Rhodes,    Bricey  Milton Florida 

Budisill,   John  David,  A.B., 

Xorth  Carolina 

Salzberg,  Abraham •  •  .  .  X'ew  York 

Saporito,   Archibald   R Xew  Jersey 


PRIZEMEN 


29 


GRADUATES — Continued. 


Name  State 

Sekerak,  Arthur  Joseph  Francis, 

Connecticut 
Shannon,   George  Edmon  ..■•...  Maryland 

Shapin,   Sydney    New  York 

Shapiro,   Louis  Mendelsohn,   B.A., 

Connecticut 
Sternberg,   Harry  Melmuth New  York 


Name  State 

Stovin,   Joseph  Samuel,   Ph.B. .  Connecticut 

Stout,   Philip  David,  B. A Tennessee 

Sweet,   Samuel  Waterman,  B.S.,  New  York 

Trynin,  Aaron  H.,  B.A New  York 

Warfield,  Jr.,  John  Ogle,  A.B., 

Pennsylvania 
Wilson,   Thomas  Norwood,   A.B. .Maryland 


PRIZEMEN. 

University  Prize — Gold  Medal J.  Ogle  Warfield,  Je. 

Certificate  of  Honor C.  Glen  McCoy. 

Certificate  of  Honor H.  Raymond  Peters, 

Certificate  of  Honor A.  V.  Buchness. 

Certificate  of  Honor Elias  Freidus. 

Certificate  of  Honor T.  Norwood  Wilson. 


In  the  third  year  the  Jose  L.  Hirsch  Memorial  Prize  of  $50.00  was 
awarded  to  Henry  Y.  Weinert  for  the  best  work  in  Pathology  during  the 
second  and  third  years. 


THE  UNIVERSITY  OF  MARYLAND 
SCHOOL  OF  MEDICINE 

AND 

COLLEGE  OF  PHYSICIANS  AND 
SURGEONS. 

As  a  result  of  the  merger  accomplished  in  1915  the  combined 
schools  offer  the  student  the  abundant  resources  of  both  institu- 
tions, and,  in  addition,  by  earlier  combination  with  the  Balti- 
more Medical  College,  the  entire  equipment  of  three  large  medical 
colleges. 

The  School  of  Medicine  of  the  University  of  Maryland  is  one  of 
the  oldest  foundations  for  medical  education  in  America,  rank- 
ing fifth  in  point  of  age  among  the  medical  colleges  of  the  United 
States.  It  was  chartered  in  1807,  under  the  name  of  the  College 
of  Medicine  of  Maryland,  and  its  first  class  was  graduated  in 
1810,  In  1812  the  College  was  empowered  by  the  Legislature 
to  annex  three  other  colleges  or  faculties,  of  Divinity,  of  Law,  and 
of  Arts  and  Sciences,  and  the  four  colleges  thus  united  were  ''con- 
stituted an  University  by  the  name  and  under  the  title  of  the 
University  of  Maryland." 

Established  thus  for  more  than  a  century,  the  School  of  Medi- 
cine of  the  University  of  Maryland  has  always  been  a  leading 
medical  college,  especially  prominent  in  the  South  and  widely 
known  and  highly  honored  throughout  the  country. 

The  beautiful  college  building  at  Lombard  and  Greene  Streets, 
erected  in  1814-1815,  is  the  oldest  structure  in  America  devoted 
to  medical  teaching.  Here  was  founded  one  of  the  first  medical 
libraries  and  the  first  medical  college  library  in  the  United 
States. 

Here  for  the  first  time  in  America  dissecting  was  made  a  com- 
pulsory part  of  the  curriculum ;  here  instruction  in  Dentistry  was 
first  given  (1837),  and  here  were  first  installed  independent 
chairs  for  the  teaching  of  Diseases  of  Women  and  Children  (1807) 
and  of  Eye  and  Ear  Diseases  (1873), 

The  School  of  Medicine  was  one  of  the  first  to  provide  for 
adequate  clinical  instruction  by  the  erection  in  1823  of  its  own 
hospital,  and  in  this  hospital  intramural  residency  for  the  senior 
student  was  first  established. 


CLINICAL    FACILITIES  31 

In  1913  juncture  was  biouglit  about  with  the  Baltimore  Medi- 
cal College,  an  institution  of  32  years'  growth.  By  this  associa- 
tion the  facilities  of  the  School  of  Medicine  were  enlarged  in  fac- 
ulty, equipment  and  hospital  connection. 

The  College  of  Physicians  and  Surgeons  was  incorporated  under 
the  Legislative  enactment  in  1872,  and  established  on  Hanover 
Street  in  a  building  afterwards  known  as  the  Maternite,  the  first 
obstetrical  hospital  in  Maryland.  In  1878  union  was  effected 
with  the  Washington  University  School  of  Medicine,  in  existence 
since  1827,  and  the  College  was  removed  to  its  present  location 
at  Calvert  and  Saratoga  Streets.  By  this  arrangement,  medical 
control  of  the  City  Hospital,  now  the  Mercy  Hospital,  was  ob- 
tained, and  on  this  foundation  in  1899  the  present  admirable 
college  building  was  erected. 


CLINICAL  FACILITIES. 

HOSPITALS  AND  DISPENSARIES. 
UNIVERSITY  HOSPITAL. 

The  University  Hospital,  which  is  the  property  of  the  Uni- 
versity of  Marjiand,  is  the  oldest  institution  for  the  care  of 
the  sick  in  the  State  of  Maryland.  It  was  opened  in  Septem- 
ber, 1823,  under  the  name  of  the  Baltimore  Infirmary,  and  at 
that  time  consisted  of  but  four  wards,  one  of  which  was  re- 
served for  eye  cases.  By  successive  additions  this  hospital  was 
increased  to  more  than  fourfold  its  original  accommodations, 
there  being  added  to  it  a  large  clinical  amphitheatre,  a  students' 
building  for  the  accommodation  of  the  thirty  clinical  assistants, 
and  a  nurses'  building  for  the  accommodation  of  the  pupils  of 
the  Training  School  for  Nurses.  The  yearly  increase  in  the  num- 
ber of  patients  seeking  admission  to  the  hospital,  however,  more 
than  kept  pace  with  the  increase  in  accommodations,  and  the 
Faculty  therefore  erected  an  entirely  new  and  modern  hospital 
of  fully  double  the  capacity  of  the  former  building. 

The  University  Hospital  is  constructed  of  brick  and  Tennessee 
limestone  in  the  Colonial  style  of  architecture,  fronting  175  feet 
upon  Lombard  Street,  and  about  the  same  on  Greene  Street.  It 
is  supplied  with  the  most  modern  and  approved  system  of  heat- 


32  CLINICAL    FACILITIES 

ing,  ventilation,  etc.,  and  equipped  with  all  modern  requirements 
and  conveniences  for  the  care  of  the  sick,  and  for  the  clinical 
instruction  of  the  students  of  the  University. 

It  is  one  of  the  largest  and  finest  hospitals  owned  and  con- 
trolled by  any  medical  school  in  America,  and  in  point  of  archi- 
tectural beauty,  convenience  and  completeness  of  arrangements 
and  equipment  compares  favorably  with  other  hospitals. 

An  important  adjunct  to  the  hospital  is  the  postmortem  build- 
ing, which  is  constructed  with  special  reference  to  the  instruction 
of  students  in  pathological  anatomy. 

The  hospital  is  situated  opposite  the  University  building,  so 
that  the  student  loses  no  time  in  passing  from  the  lecture  halls 
to  the  clinical  amphitheatre,  dispensary  and  wards. 

A  portion  of  the  hospital  is  used  as  a  marine  hospital  for  for- 
eign seamen.  The  great  importance  of  Baltimore  as  a  shipping 
point  brings  into  her  harbor  many  vessels  from  all  parts  of  the 
world,  and  the  sick  sailors  who  are  cared  for  in  the  wards  of  the 
institution  give  the  students  an  opportunity  to  observe  a  large 
variety  of  diseases.  Another  considerable  portion  of  the  building 
is  used  as  a  Municipal  Hospital,  and  contains  charity  beds  sup- 
ported by  the  City  of  Baltimore.  This  department  of  the  hospital 
is  taxed  to  its  utmost  capacity  to  afford  accommodations  for  the 
patients  seeking  admission. 

Owing  to  its  location,  being  the  nearest  hospital  to  the  largest 
manufacturing  district  of  the  city,  the  University  Hospital  re- 
ceives for  treatment  a  very  large  number  of  accident  cases  of  all 
kinds,  both  slight  and  serious.  These  cases,  as  well  as  patients 
suffering  from  the  various  diseases  of  our  own  climate,  occupy 
the  beds,  and  add  greatly  to  the  facilities  of  clinical  teaching 
enjoyed  by  the  school.  The  facilities  for  clinical  instruction  have 
been  greatly  enlarged  by  an  appropriation  by  the  State  of  Mary- 
land for  the  support  of  free  beds  for  patients  from  the  various 
counties. 

MERCY  HOSPITAL. 

The  Sisters  of  Mercy  first  assumed  charge  of  the  Hospital  at  the 
corner  of  Calvert  and  Saratoga  streets,  then  owned  by  the  Wash- 
ington University,  in  1875.  By  the  merger  of  1878  the  Hospital 
came  under  the  control  of  the  College  of  Physicians  and  Surgeons, 
but  the  Sisters  continued  their  work  of  administering  to  the 
patients. 

In  a  very  few  years  it  became  apparent  that  the  City  Hospital, 
as  it  was  then  called,  was  much  too  small  to  accommodate  the 


CLINICAL    FACILITIES  33 

rapidly  growing  demands  upon  it.  However,  it  was  not  until 
1888  that  the  Sisters  of  Mercy,  with  the  assistance  of  the  Faculty 
of  the  College  of  Physicians  and  Surgeons,  were  able  to  lay  the 
cornerstone  of  the  present  Hospital.  This  building  was  completed 
and  occupied  late  in  1889.  Since  then  the  growing  demands  for 
more  space  has  compelled  the  erection  of  additions,  until  now 
there  are  accommodations  for  351  patients. 

In  1909  the  name  was  changed  from  The  Baltimore  City  Hos- 
pital to  Mercy  Hospital. 

Mercy  Hospital  is  located  in  the  center  of  a  city  of  750,000 
inhabitants,  and  is  under  the  exclusive  medical  control  of  the 
College  of  Physicians  and  Surgeons.  It  adjoins  the  College  build- 
ing, and  all  surgical  patients  from  the  public  wards  are  operated 
upon  in  the  College  operating  rooms.  This  union  of  the  Hospital 
and  College  buildings  greatly  facilitate  the  clinical  teaching,  as 
there  is  no  time  lost  in  passing  from  one  to  the  other. 

Mercy  Hospital  is  the  hospital  of  the  United  Railways  and 
Electric  Company  of  Baltimore  City,  and  receives  patients  from 
the  Baltimore  &  Ohio  Railroad  Company  and  from  the  Pennsyl- 
vania Railroad  Company  and  its  branches. 

FRANKLIN  SQUARE  HOSPITAL. 

The  Franklin  Square  Hospital  has  a  capacity  of  112  beds.  Dur- 
ing the  year  ending  December  31,  1920,  1,860  cases  were  treated 
in  the  hospital,  and  1,89G  patients  were  treated  in  the  dispensary. 
Eleven  hundred  and  forty-eight  surgical  operations  were  per- 
formed in  the  hospital. 


LYING-IN  HOSPITALS. 
MATERNITY  HOSPITAL  OF  THE   UNIVERSITY  OF  MARYLAND. 

This  institution  is  also  the  property  of  the  University,  and 
under  its  exclusive  control  and  direction,  and  is  conducted 
with  the  special  purpose  of  furnishing  actual  obstetrical  experi- 
ence to  each  member  of  the  graduating  class. 

New  accommodations  have  been  provided  in  the  general  hospi- 
tal, and  the  Maternity  Department  now  offers  better  facilities 
than  ever  before,  while  the  large  increase  in  clinical  material  has 
made  it  possible  to  offer  excellent  opportunities  for  post-graduate 
work. 


34  CLINICAL    FACILITIES 

I 

THE  WEST  END  MATERNITY. 

The  West  End  Maternity  adjoins  the  Franklin  Square  Hospital 
and  furnishes  an  abundance  of  clinical  material,  which  is  under 
the  control  of  the  Faculty  of  Physic. 

OUT-PATIENT  CLINIC  AND  DISPENSARY. 

In  connection  with  the  University  Hospital  an  out-door  obstet- 
rical clinic  is  conducted,  in  which  every  case  has  careful  prenatal 
supervision,  is  attended  during  labor  by  a  graduate  physician  and 
graduate  nurse — one  senior  student  also  being  present — and  is 
visited  during  the  puerperium  by  the  attending  student  and  grad- 
uate nurse.  Careful  prenatal,  labor  and  puerperal  records  are 
kept,  making  this  work  of  extreme  value  to  the  medical  student, 
not  only  from  the  obstetrical  standpoint,  but  in  making  him  ap- 
preciate the  value  of  social  service  and  public  health  work. 

NUMBER  OF  PATIENTS. 

During  the  year  ending  December  31,  1921,  the  number  of  pa- 
tients treated  in  the  Lying-in  hospitals  connected  with  the  School 
was  as  follows: 

Number  of  Coufiuements  iu  Hospitals 371 

Number  of  Confinements  Out-Patient  Department SOI 

Average  number  of  cases  seen  by  each  student  of  tbe  graduating  class    15 

THE  MUNICIPAL  HOSPITALS— BAY  VIEW. 

The  clinical  advantages  of  the  University  have  been  largely  in- 
creased by  the  liberal  decision  of  the  Board  of  Supervisors  of  City 
Charities  to  allow  the  immense  material  of  these  hospitals  to  be 
used  for  the  purpose  of  medical  education.  There  are  daily  visits 
and  clinics  in  medicine  and  surgery  by  the  Staff  of  the  hospitals. 
The  autopsy  material  is  unsurpassed  in  this  country  in  amount, 
thoroughness  in  study,  and  the  use  made  of  it  in  medical  teach- 
ing. 

The  Municipal  Hospitals  consist  of  the  following  separate  hos 
pitals : 

The  General  Hospital,  KiO  beds. 

The  Hospital  for  Chronic  Cases,  SS  beds. 

The  Municipal  Hospital  for  Tuberculosis,  190  beds. 

City  Detention  Hospital  for  Insane,  450  beds. 


CLIISriCAL    FACILITIES  35 

THE  JAMES  LAWRENCE  KERNAN  HOSPITAL  AND  INDUSTRIAL 
SCHOOL  OF  MARYLAND  FOR  CRIPPLED  CHILDREN. 

This  institution  contains  seventy-five  beds  for  the  active  treat- 
ment of  deformities.  It  is  situated  at  "Eadnor  Park,"  a  colonial 
estate  of  seventy-five  acres  at  Hillsdale,  within  the  western  city 
limits,  reached  by  trolley. 

This  institution  has  city,  state,  endowed  and  private  beds  and 
every  modern  facility  for  the  treatment  of  orthopedic  cases  as 
well  as  a  most  beautiful  park-like  environment  and  farm,  and  is 
closely  affiliated  with  the  University  of  Maryland,  for  bed-side 
instruction. 

ST.  VINCENT'S  INFANT  ASYLUM. 

The  facilitiess  of  this  institution,  containing  250  infants  and 
children,  have  been  kindly  extended  to  the  University  of  Maryland 
by  the  Sisters  of  Charity.  This  large  clinic  enables  this  school  to 
present  to  its  students  liberal  opportunities  for  the  study  of  dis- 
eases of  infants  and  children. 


INSTITUTIONS    FOR     THE     TREAT3IENT     OF     THE     INSANE     AND 

FEEBLE-MINDED. 

The  Sheppard  and  Enoch  Pratt  Hospital  for  the  Insane. 
This  institution  is  one  of  the  most  modern  hospitals  for  the  treat- 
ment and  care  of  the  insane  in  this  country.  It  is  well  endowed 
and  its  superintendent  is  R.  M.  Chapman,  M.  D.,  Professor 
of  Psychiatry  at  the  I^niversity  of  Maryland.  In  this  hospital 
intensive  treatment  and  study  of  mental  diseases  is  carried  on,  a 
large  number  of  the  patients  entering  voluntarily.  The  students 
under  the  direction  of  Dr.  Chapman  and  his  assistants  in  a  series 
of  clinics  are  shown  the  early  manifestations  and  the  various 
stages  of  mental  diseases,  the  methods  of  treatment,  and  their 
effects. 

Mount  Hope  Retreat  for  the  Insane.  This  hospital  contains 
an  average  of  750  patients  and  is  attended  by  Dr.  Chas.  G.  Hill, 
Professor  of  Psychiatry  of  this  faculty.  Under  the  direction  of 
Dr.  Hill  and  his  assistants  the  students  are  given  opportunity  for 
the  study  of  large  groups  of  patients  showing  all  phases  of  vari 
ous  mental  and  nervous  disorders. 


6b  JJISPENSARIES 

DISPENSARIES. 

The  dispensaries  associated  with  the  University  Hospital  and 
the  Mercy  Hospital  are  organized  upon  a  uniform  plan  in  order 
that  the  teaching  may  be  the  same  in  each.  Each  dispensary  has 
the  following  departments :  Medicine,  Surgery,  Children,  Eye 
and  Ear,  Genito-Urinary,  Gynecology,  Gastro-Enterology,  Neurol- 
ogy, Orthopedics,  Proctology,  Dermatology,  Throat  and  Xose» 
Tuberculosis  and  Psychiatry. 

All  students  in  their  junior  year  work  in  the  departments  of 
Medicine  and  Surgerj^  each  day  in  one  of  the  dispensaries. 

All  students  in  their  senior  year  work  in  the  special  depart- 
ments one  hour  each  day. 

Some  idea  of  the  value  of  these  dispensaries  for  clinical  teach- 
ing is  shown  by  the  number  of  patients  treated.  For  the  year 
1921  about  eighty-four  thousand  visits  were  made  to  the  dispen- 
saries. 

In  addition  to  these  the  Dental  Department,  situated  upon  the 
grounds  of  the  University,  conducts  a  daily  clinic  which  is  open 
to  medical  students. 


University  Hospital  Dispensary  Report,  January  1  to  DecemJ)er  31,  1921. 
./.  A.  SkladOHSky,  M.D.,  Dispensary  Physician. 

Department.  New  Cases. 

Dermatological 2,437 

Cliildi-en 1.912 

Obstetrical 1.406 

Surgical 1,292 

Eye  and  Ear 1.090 

Gynecological 1  ,S42 

Medical 1.066 

Genito-Urinary.  .  .    .- ."i44 

Neurological 1 69 

( )rthoi)edics 139 

(iastro-Enterological 185 

Nose  and  Throat 721 

Tulierculosis 169 

I'roctological 8.5 

I'sychiatry 14 

13,071  39,566        .j2,63r 


Old  Cases. 

Total. 

5.533 

7.970 

10,142 

12,054 

3,617 

5.023 

3,425 

4,717 

2,273 

3,363 

3,990 

5.832 

2,264 

3.330 

3,126 

3,670 

1,574 

1,743 

1,594 

1,733 

883 

1,068 

845 

1.566 

158 

327 

127 

212 

15 

29 

LABORATORIES  37 

Mercy  Hospital  Dispensary  Report,  January  1  to  December  31,  1921. 
Sister  M.  Helen,  R.N.,  Directress. 

Dispensary  Clinics.  JSiew  Cases. 

Surgical 933 

Medical 91S 

Gynecological 339 

Eye  and  Ear 420 

Nose  and  Throat 516 

Neurological 179 

Pediatric 85 

Gastro-Intestinal 207 

Dental 60 

Proctological 42 

Orthopedic SS 

Dermatological 271 

Genito-Uriuary  Surgery   1,6S1 


Old  Cases. 

Total. 

2,530 

3,463 

816 

1,734 

753 

1,092 

680 

1,100 

783 

1,299 

543 

722 

61 

146 

897 

1,104 

IS 

78 

24 

66 

298 

386 

572 

843 

17,910 

19,591 

5,739  25,885         31,624 

LABORATORIES. 

ANATOMICAL  LABORATORIES. 

These  laboratories  are  in  charge  of  the  Professor  of  Anatomy 
and  his  assistants.  The  University  has  recently  built  its  own 
storage  and  embalming  plant,  which  supplies  an  abundance  of 
anatomical  material.  Anatomical  material  is  furnished  in  abun- 
dance, free  of  charge. 

LABORATORY  OF  EXPERIMENTAL  PHYSIOLOGY. 

This  laboratory  occupies  the  first  floor  of  Gray  Laboratory;  it 
includes  a  large  student  laboratory,  with  capacity  of  forty  stu- 
dents, a  room  completely  equipped  for  mammalian  experimenta- 
tion, a  stock-room,  and  an  oflSce  for  the  professor  in  charge. 
Within  the  same  building  there  is  an  animal  room  in  which  there 
is  kept  a  constant  supply  of  material  for  experimentation  and 
demonstration.  The  laboratory  is  equipped  with  ample  appara- 
tus: there  is  a  complete  set  of  student  apparatus  available  for 
each  group  of  two  students,  while  the  special  apparatus  for  lab- 
oratory experimentation  and  class-room  demonstration  is  ade- 
quate for  the  needs  of  the  courses. 


38  lABOEATORIES 

LABORATORY  OF  BIOLOGICAL  CHEMISTRY. 

(See  page  55.) 

LABORATORY  OF  HISTOLOGY  AND  EMBRYOLOGY. 

This  laboratory  is  fully  equipped  for  teaching  Histology  and 
Embryology. 

There  is  a  large  collection  of  charts,  specimens  and  apparatus 
used  in  teaching.  The  necessary  equipment  for  the  practice  of 
technique  is  provided. 

LABORATORIES  OF  PATHOLOGY  AND  BACTERIOLOGY. 

The  subject  of  special  bacteriology  is  taught  during  a  portion  of 
the  second  year  in  a  well  equipped  laboratory  containing  steriliz- 
ers, water  baths,  and  other  necessary  equipment  for  this  purpose. 

The  subject  of  histopatholog}'  is  also  taught  during  the  second 
year  in  a  properly  equipped  laboratory.  The  details  concerning, 
this  work  are  described  under  the  subject  of  Department  of  Path- 
ology and  Bacteriology. 

The  instruction  in  gross  pathology  is  obtained  during  the  third 
year  by  attendance  upon  the  autopsies  at  the  University  Hospital 
and  the  Mercy  Hospital,  and  special  instruction  in  this  subject 
is  also  given  by  demonstrations  with  a  large  amount  of  pathologi- 
cal material  at  the  City  Hospitals  situated  at  Bay  View.  The 
subject  of  gross  pathology  is  also  taught  in  the  third  year  by 
means  of  lectures  and  demonstrations  to  sections  of  the  third 
year  class  and  a  special  effort  is  made  to  apply  this  subject  to  the 
explanation  of  the  symptoms  and  clinical  signs  of  disease.  The 
instruction  in  autopsy  technique  is  also  given  personally  to  small 
groups  of  students. 

LABORATORIES  OF  CLDflCAL  PATHOLOGY. 

These  laboratories  are  fully  equipped  for  the  study  of  practical 
laboratory  work  in  its  relationship  to  clinical  medicine.  Each 
student  is  supplied  with  a  locker,  containing  suflScient  apparatus 
for  any  ordinary  examination. 

The  wards  and  out-patient  departments  of  the  hospitals  furnish 
an  abundance  of  material  for  study. 

By  reason  of  individual  equipment,  much  work  outside  of  class 
hours  is  expected  of  the  student. 

The  class  rooms  are  adequately  lighted,  and  are  conveniently 
situated  for  teaching  purposes. 


ANNUAL  APPOINTMENTS  39 

LIBRARIES. 

The  University  Library,  founded  in  1813  by  the  purchase  of  the 
collection  of  Dr.  John  Crawford,  now  contains  14,610  volumes,  a 
file  of  58  current  journals,  and  several  thousand  pamphlets  and 
reprints.  During  the  year  ending  December  31,  1921,  351  volumes 
were  added.  It  is  well  stocked  with  recent  literature,  including 
books  and  periodicals  of  general  interest.  The  home  of  the  Library 
is  Davidge  Hall,  a  comfortable  and  commodious  building  in  close 
proximity  to  the  class  rooms  and  the  laboratories  of  the  Medical 
Department.  The  Library  is  open  daily  during  the  year,  except 
in  August,  for  use  of  members  of  the  Faculty,  the  students,  and 
the  profession  generally. 

The  Library  of  the  Medical  and  Chirurgical  Faculty  of  Mary- 
land, containing  many  thousands  of  volumes,  is  .open  to  the  stu- 
dents of  the  school.  The  leading  medical  publications  of  the 
world  are  received  by  the  library  and  complete  sets  of  many  jour- 
nals are  available.  Other  libraries  of  Baltimore  are  the  Peabody 
(181,000  volumes)  and  the  Enoch  Pratt  Free  Library  (355,817 
volumes). 

All  these  libraries  are  open  to  the  students  of  the  school  with- 
out charge. 

The  proximity  of  Washington  places  the  immense  libraries  of 
the  national  capital  at  the  disposal  of  the  students  of  the  school. 


ANNUAL  APPOINTMENTS. 

On  February  first  of  each  session  the  following  annual  appoint- 
ments are  made  from  among  the  graduates  of  the  school : 

TO   THE   UNIVERSITY   HOSPITAL 

Medical  Superintendent. 
Five  Senior  Residents,  viz: 

Two  Resident  Surgeons. 

One  Resident  Physician. 

One  Resident  Gynecologist  and  Obstetrician. 

One  Resident  Patliologist. 
Thirteen  Junior  Residents  on  a  rotating  service. 

A  number  of  students  are  appointed  each  year,  at  the  close  of 
the  session,  as  Clinical  Assistants  in  the  University  Hospital  for 
the  summer  months. 


40  REQUIREMENTS  FOR  MATRICULATION 

TO  THE   MERCY   HOSPITAL. 

Chief  Resident  Physician. 
Six  Resident  Surgeons. 
Four  Resident  Physicians. 
One  Resident  Gynecologist. 
One  Resident  Obstetrician. 

TO   THE   MABYLAND  GENEKAL   HOSPITAL. 

;  Medical  Superintendent: 

Four  Senior  Residents,  viz : 
One  Resident  Surgeon. 
One  Resident  Physician. 
One  Resident  Gynecologist. 
One  Resident  Obstetrician. 
Eight  Junior  Residents  on  a  rotating  service. 

Each  resident  serves  a  term  in  every  department,  including  the 
pathological  laboratory  and  the  Maryland  Lying-in-Hospital. 

Many  appointments  to  other  hospitals  of  Baltimore  are  made 
annually,  to  which  graduates  of  this  school  are  eligible. 

r  _  KEQUIREMENTS  FOR  MATRICULATION. 

I 

Admission  to  the  course  in  medicine  is  by  a  completed  Medical 
student  Certilicate  issued  by  the  Registrar  of  the  University 
of  Maryland.  This  certificate  is  obtained  from  the  Registrar 
on  the  basis  of  satisfactory  credentials,  or  by  examination  and 
credentials,  and  is  essential  for  admission  to  any  class. 

The  requirements  for  the  issuance  of  the  Medical  Student  Cer- 
tificate are: 

(a)  The  completion  of  a  standard  four-year  high  school  course 
or  the  equivalent,  and  in  addition, 

(b)  Two  years  or  sixty  semester  hours  of  college  credits,  in- 
cluding chemistry,  biology,  physics,  and  English. 

Women  are  admitted  to  the  Medical  Department  of  this  Uni- 
versity. 

(A)  DETAILS  OF  THE  HIGH  SCHOOL  REQUIREMENT. 

1.  Graduation  from  an  accredited  high  school  after  pursuing  a 
four-year  course  based  upon  an  eight-year  elementary  course  or 
its  full  equivalent ;  or 

2.  Successfully  passing  entrance  examinations  in  the  following 
subjects : 


REQUIREMENTS  FOR  MATRICULATION  41 

(a)  Required  Eleven  (11)   Units. 

Units. 

English,  4  years 3 

Elementary  and  Intermediate  Algebra 1 

Plane  Geometry  ( first  five  books) 1 

Two  years  of  a  foreign  language 2 

Two  of  the  three  sciences — Biology,  Chemistry,  Physics 2 

American  History  and  Civics 1 

Ancient  History  or  English  History 1 

(&)  Electives,  Four  (4)   Units. 

(1)  History  and  Political  Science: 

Ancient  History  or  English  History 1 

Mediaeval  and  Modern  History 1  or  ^ 

General  History 1  or  % 

Civics    : % 

Economics  % 

(2)  Language: 

French  2  years 2 

German  2  years : 2 

Greek  2  years 2 

Hebrew  2  years 2 

Italian  2  years 2 

Latin  1  or  2  years lor  2 

Spanish  2  years 2 

(3)  Mathematics: 

Advanced  Arithmetic   % 

Advanced  Algebra 1 

Plane  Trigometry    % 

Solid  Geometry i/^ 

(4)  Science : 

Physics,  Biology  or  Chemistry 1 

Physical  Geography  and  Geology 1 

Astronomy    ^^ 

Physiology  and  Hygiene Va 

(5)  Vocational  and  cultural  subjects: 

Agriculture    1 

Bookkeeping 1 

Commercial  Geography    % 

Domestic  Science 1 

(    Mechanical  1  and  2 i/{.  each 

Drawing    ^    Freehand  1  and  2 V2  each 

Manual  Training 1 

Music    1 

Stenography    1  or  2 


42  REQUIREMENTS  FOE  MATRICULATION 

■  One  unit  in  any  subject  is  the  equivalent  of  worli  iu  that  subject  for  five 
periods  per  week  for  a  year  of  at  least  thirty-six  weeljs.  periods  to  be  not 
less  than  forty-five  minutes  iu  length.  One  unit  is  equivalent  to  2  semester 
credits  or  2  points. 

(B)     DETAILS  OF  THE  COLLEGE  REQUIREMENT. 

a.  The  preliminary  college  course  shall  extend  through  two  col- 
lege sessions  of  at  least  thirty-two  weeks  each  of  actual  instruc- 
tion, including  final  examinations. 

1).  In  excellence  of  teaching  and  in  content,  the  work  of  this  pre- 
liminary college  course  shall  be  equal  to  the  work  done  in  the 
freshman  and  sophomore  years  in  standard  colleges  and  universi- 
ties. 

c.  This  preliminary  college  course  shall  include  courses  in  phy- 
sics, chemistry,  biology,  and  English,  each  course  to  embrace  at 
least  six,  eight  or  twelve  hours  of  work  in  each  subject,  as  shown 
in  the  schedule  following. 

SCHEDULE  OF  SUBJECTS  OF  THE  TWO-TEAR  PRE-MEDICAL 
COLLEGE  COURSE. 

Sixty  Semester  Hours  Required.  Semester 

Required  Courses  :  Hours. 

Chemistry    (a )    12 

Physics  (b)   8     , 

Biology   (c)    8 

English  Composition  and  Literature   (d)... 6 

Courses  Strongly  Urged  : 
A  modern  foreign  language. 
Comparative  vertebrate  anatomy 
Psychology 
Social  science 

A  semester  hour  is  the  credit  value  of  sixteen  weeks'  work  consisting  of 
one  lecture  or  recitation  period  per  week,  each  period  to  be  of  not  less  than 
fifty  minutes'  duration  net,  at  least  two  hours  of  laboratory  work  to  be 
considered  as  the  equivalent  of  one  lecture  or  recitation  period. 

(a)  Chemistry.  Twelve  semester  hours  required,  of  which  at 
least  eight  semester  hours  must  be  in  general  inorganic  chemistry, 
including  four  semester  hours  of  laboratory  work.  In  the  inter- 
pretation of  this  rule,  work  in  qualitative  analysis  may  be  counted 
as  general  inorganic  chemistry.  The  remaining  four  semester 
hours  required  shall  consist  of  work  in  organic  chemistry. 


KEQUIKEMENTS  FOE   MATKICULATION  43 

(b)  Physics.  Eight  semester  hours  required,  of  which  at  least 
two  must  be  laboratory  work.  This  course  presupposes  a  knowl- 
edge of  plane  trigonometry. 

(c)  Biology.  Eight  semester  hours  required,  of  which  four 
must  be  laboratory  work.  This  requirement  may  be  satisfied  by 
a  course  of  eight  semester  hours  in  either  general  biology  or  zoo- 
logy, or  by  courses  of  four  semester  hours  each  in  zoology  and 
botany,  but  not  by  botany  alone.  The  requirement  may  be  satis- 
fied also  by  6  semester  hours  of  college  biology,  including  three 
semester  hours  in  laboratory  work,  if  preceded  by  a  year  (one 
unit)  of  high  school  biolog}'. 

(d)  English  Composition  and  Literature.  The  usual  intro- 
ductory college  course  of  six  semester  hours,  or  its  equivalent,  is 
required. 

POST-GRADUATE  STUDENTS. 

Graduates  in  medicine  desiring  to  take  the  work  of  the  senior 
year  without  being  candidates  for  the  degree  and,  therefore,  with- 
out examination,  may  receive  a  certificate  of  attendance  on  com- 
pleting the  full  course  satisfactorily. 

The  requirements  for  graduates  in  medicine  admitted  to  the 
fourth  year  class  as  candidates  for  the  degree  of  Doctor  of  Medi- 
cine are  the  same  as  those  enforced  against  undergraduates  ad- 
mitted to  advanced  standing, 


COMBINED  COURSE  IN  ARTS  AND  MEDICINE. 

Students  who  have  completed  the  junior  year  in  our  School  of 
Liberal  Arts  and  who  have  made  an  approved  choice  of  electives 
may,  if  they  desire,  do  the  entire  work  of  the  senior  year  in  the 
medical  school  of  the  University.  If  they  successfully  complete 
the  work  of  the  first  medical  year  they  are  graduated  with  their 
class  with  the  degree  of  Bachelor  of  Arts. 

By  taking  advantage  of  this  privilege  a  man  may  complete  the 
Undergraduate  and  Medical  courses  in  seven  years. 

During  three  of  these  years  or  until  he  has  completed  the  work 
of  the  junior  class  he  is  a  resident  student  in  the  School  of  Lib- 
eral Arts  at  College  Park.  Maryland,  and  for  four  years  he  is  a 
student  in  the  Medical  School  in  Baltimore. 

At  The  end  of  the  fourth  year  he  receives  the  A.B.  degree,  and 
at  the  end  of  the  seventh  vear  the  INI.D.  degree,  but  credit  from 


44  KEQUIREMENTS  FOR  MATRICULATION 

the  Medical  School  cannot  be  accepted  in  subjects  for  which  credit 
has  already  been  given  in  the  School  of  Liberal  Arts. 

The  same  privilege  is  allowed  students  of  St.  John's  College, 
Annapolis,  Maryland. 

Special  premedical  courses  have  been  arranged  in  our  School  of 
Liberal  Arts  at  College  Park  and  also  by  St.  John's  College  at 
Annapolis. 


KULES. 

1.  All  students  are  required  to  take  the  spring  examinations 
unless  excused  by  the  Dean.  No  student  will  be  permitted  to 
advance  from  a  lower  to  a  higher  class  with  conditions. 

2.  Should  a  student  be  required  to  repeat  any  year  in  the  course 
he  must  pay  regular  fees. 

3.  A  student  failing  in  final  examinations  for  graduation  at  the 
end  of  the  fourth  year  will  be  required  to  repeat  the  entire  course 
of  the  fourth  year  and  to  take  examinations  in  such  other 
branches  as  may  be  required,  should  he  be  again  permitted  to 
enter  the  school  as  a  candidate  for  graduation. 

4.  The  general  fitness  of  a  candidate  for  graduation  will  be 
taken  into  consideration  by  the  Faculty  as  well  as  the  results  of 
his  examinations. 

All  the  above  rules,  as  well  as  the  fees  stated  below,  relate  to 
the  year  ending  June  9,  1923,  only.  The  right  is  reserved  to  make 
changes  in  the  curriculum,  requirements  for  graduation,  fees  and 
any  of  the  regulations  whenever  the  facult}'  deem  it  expedient. 


FEES. 

Matriculation  fee  (paid  each  year) $5.00 

Tuition  fee  (each  year)  for  residents  of  Maryland 2.50.00 

Tuition  fee  (each  year)  for  non-residents 300.00 

Breakage  fee  (each  year ) 10.00 

Special  and  re-exauiination  fee ,5.00 

No  fees  are  returnable,  except  unused  portion  of  .breakage  fee. 
Tuition  fees  are  due  and  payable  during  October. 
The  above  fees  apply  to  all  students  who  matriculate  in  this 
institution  in  anv  class  for  the  session  beginning  October  2,  1922. 


PRIZES  '  45 

SPECIAL  COUKSES. 

Auatoniy    $75.00 

Physiology    75.00 

Pathology    75.00 

Embryology    75.00 

Bacteriology    75.00 

Biological  Chemistry   75.00 

Pharmacology   75.00 

Cliuical  Laboratory    (four  mouths) 100.00 

X-Ray    (four  months) 150.00 

Orthopedic  Surgery    (four  months) 150.00 

Genito-Urinary  Diseases  (four  months) 150.00 

Gynecology  and  Gynecological  Pathology 100.00-150.00 

(  6  weeks    $25.00 

Obstetrics,  Out-door |  4  ji^onths  50.00 

(  6  weeks    50.00 

Out-Door  and  In-Door  -J  ^  ,^^^,^1^,    ^^  0^ 

(Clinical  Surgery     1 
SurgeryJ  Operative  Surgery  L By  arrangement 

I  Surgical  Pathology  I 

Medicine   By  arrangement 

Laboratory  Technician  Course,  including  Bacteriology  and  Clinical 

Pathology    .$150.0O' 

If  the  courses  are  taken  during  holidays  or  if  special  super- 
vision is  desired  or  additional  material  required,  the  charge  is 
made  accordingly. 


FACULTY  PRIZE. 

To  stimulate  study  among  the  candidates  for  graduation,  the 
Faculty  offers  a  Gold  Medal  to  the  candidate  who  passes  the  best 
general  examination.  Certificates  of  Honor  are  awarded  to  the 
five  candidates  standing  next  highest. 


JOSE  L.  HIESCH  MEMORIAL  PRIZE. 

A  prize  of  |50.00  is  given  each  year  by  Mrs.  Jose  L.  Hirsch  as  a 
memorial  to  the  late  Dr.  Jose  L.  Hirsch,  formerly  Professor  of 
Pathology  in  this  school,  to  the  student  in  the  third  year  who  has 
done  the  most  satisfactory  work  in  Pathology  during  his  second 
and  third  vears. 


46  SCHOLAESHIPS 

SCHOLARSHIPvS. 

The  Dr.  Samuel  Leon  Frank  Scholarship. 

This  scholarship,  established  by  Mrs.  Bertha  Eayner  Frank  as 
a  memorial  of  the  late  Dr.  Samuel  Leon  Frank,  an  alumnus  of 
this  University,  entitles  the  holder  to  exemption  from  the  pay- 
ment of  the  tuition  fee  of  that  year. 

It  is  awarded  by  the  Trustees  of  the  Endowment  Fund  of  the 
University  each  year  upon  uominatiou  of  the  Medical  Council, 
"to  a  medical  student  of  the  University  of  Maryland,  who,  in  the 
judgment  of  said  Faculty,  is  of  good  character  and  in  need  of  pe- 
cuniary assistance  to  continue  his  medical  course." 

This  scholarship  is  awarded  to  a  second,  third  or  fourth  year 
student  only,  who  has  successfully  completed  one  year's  work  in 
the  medical  course,  and  no  student  may  hold  such  scholarship  for 
more  than  two  years. 

The  Charles  M.  Hitchcock  Scholarships. 

From  a  bequest  to  the  School  of  Medicine  by  the  late  Charles 
M.  Hitchcock,  M.D.,  an  alumnus  of  the  University,  two  scholar- 
shii)s  have  been  established  which  entitle  the  holders  to  exemption 
from  payment  of  tuition  fees  for  the  year. 

These  scholarships  are  awarded  annually  by  the  Medical  Coun- 
cil to  students  who  have  meritoriously  completed  the  work  of  at 
least  the  first  year  of  the  course  in  medicine,  and  who  present  to 
the  Faculty  satisfactory  evidence  of  good  moral  character  and  of 
inability  to  continue  the  course  without  pecuniary  assistance. 

The  Randolph  AVinslow  Scholarship. 

This  scholarship,  established  by  Prof.  Randolph  Winslow.  M.D;, 
LL.D.,  entitles  the  holder  to  exemption  from  tlie  payment  of  the 
tuition  fee  of  that  year. 

It  is  awarded  annually  by  the  Trustees  of  the  Endowment  Fund 
of  the  University,  upon  nomination  of  the  Medical  Council,  to  ''a 
needy  student  of  the  Senior,  Junior,  or  Sophomore  Class  of  the 
Medical  School." 

''He  must  have  maintained  an  average  grade  of  85%  in  all  his 
work  up  to  the  time  of  awarding  the  scholarship." 

"He  must  be  a  person  of  good  character  and  must  satisfy  the 
Medical  Council  that  he  is  worthy  of  and  in  need  of  assistance-" 


SCHOLARSHIPS  4:7 

THE  LEO  KAIILTNSKY  SCHOLAESHIP. 

This  scholarship,  established  by  Mrs.  TJay  Alintz  Karliusky  as 
a  memorial  to  her  husbaud,  the  late  Dr.  Leo  Karlinsky,  an 
alumnus  of  the  University,  entitles  the  holder  to  exemption  from 
the  payment  of  the  tuition  fee  of  that  year. 

It  is  awarded  annually  by  the  Trustees  of  the  Endowment 
Fund  of  the  University,  upon  nomination  of  the  Medical  Council, 
to  "a  needy  student  of  the  Senior,  Junior  or  Sophomore  Class  or 
the  Medical  School." 

"He  must  have  maintained  an  average  grade  of  85  per  cent,  in 
all  his  work  up  to  the  time  of  aw  arding  the  scholarship." 

"He  must  be  a  person  of  good  character  and  must  satisfy  the 
Medical  Council  that  he  is  worthy  of  and  in  need  of  assistance.'* 

The  University  Scholarships. 

Two  Scholarships  are  awarded  by  the  University.  One  to  a  stu- 
dent of  the  Department  of  Liberal  Arts  appointed  by  the  Presi 
dent;  the  other,  which  entitles  the  holder  to  exemption  from 
payment  of  the  tuition  fee  of  the  year,  is  awarded  annually  by  the 
Medical  Council  to  a  student  of  the  Senior  Class  who  presents  to 
the  Medical  Council  satisfactory  evidence  that  he  is  of  good  moral 
character  and  is  worthy  of  and  in  need  of  assistance  to  complete 
the  course. 

The  St.  John^s  Scholarship. 

This  scholarship  is  awarded  annually  by  the  Medical  Council 
upon  the  nomination  of  the  President  of  St.  John's  College. 

It  entitles  the  holder  to  exemption  from  the  payment  of  the 
tuition  fee  of  that  year. 

Frederica  Gbhrmann  Scholarship. 

This  scholarship  was  established  by  bequest  of  the  late  Mrs. 
Frederica  Gehrmann  and  entitles  the  holder  to  exemption  from 
payment  of  tuition  fees.  This  scholarship  is  awarded  to  a  second 
year  student  who  at  the  end  of  the  year  passes  the  best  practical 
examination  in  Anatomy,  Physiology,  Biological  Chemistry, 
Pharmacology,  Pathology,  Immunology  and  Serology. 

NOTICE  TO  STUDENTS. 

The  personal  expenses  of  students  are  at  least  as  low  in  Balti- 
more as  in  any  large  city  in  the  United  States.     The  following 


48  OEGANIZATION"   OF  THE   CUERICULUM 

estimates  of  student's  personal  expenses  for  the  academic  year  of 
eight  months  have  been  prepared  by  students,  and  are  based  upon 
actual  experience: 

Items.  Low.        Average.  Liberal. 

Books    $27  $48  $75 

College  Incidentals   20  20  20 

Board,  eiglit  months 200  250  275 

Room  rent   64  80  100 

Clothing  and  laundry 50  80  150 

All  other  expenses 25  50  75 

Total    $386  $529  $695 

Students  will  save  time  and  expense  upon  their  arrival  in  the 
city  by  going  direct  to  the  School  of  Medicine  on  the  University 
grounds,  N.  E.  corner  of  Lombard  and  Greene  Streets,  where  the 
Superintendent  of  Buildings,  who  may  be  found  at  his  office  on 
the  premises,  will  furnish  them  with  a  list  of  comfortable  and 
convenient  boarding  houses  suitable  to  their  means  and  wishes. 

The  Dean  will,  if  desired,  attend  to  the  collection  of  checks  and 
drafts  for  students. 

For  further  information  apply  to 

J.  M.  H.  Rowland,  M.D.,  Dean, 
Lombard  and  Greene  Streets. 


ORGANIZATION  OF  THE  CURRICULUM. 

The  following  curriculum  is  the  result  of  a  thorough  re- 
vision of  teaching  in  this  school  in  order  to  meet  modern  re- 
quirements. The  multiplication  of  specialties  in  medicine  and 
surgery  necessitates  a  very  crowded  course  and  the  introduction 
of  electives  will  very  soon  be  depended  on  to  solve  some  of  the 
difficulties. 

The  curriculum  is  organized  under  eleven  departments: 

1.  Anatomy  (including  Histology  and  Embryology). 

2.  Physiology. 

3.  Biological  Chemistry. 

4.  Pharmacology  and  Materia  Medica. 

5.  Pathology. 

6.  Bacteriologv. 


OEGANIZATION   OF  THE  CUEKICULTJM  49 

7.  Medicine  .(including  Medical  Specialties). 

8.  Surgery  (including  Surgical  Specialties). 

9.  Obstetrics. 

10.  Gynecology. 

11.  Ophthalmology  and  Otology. 

The  instruction  is  given  in  four  years  of  graded  work. 

Several  courses  of  study  extend  through  two  years  or  more,  but' 
in  no  case  are  the  students  of  different  years  thrown  together  in 
the  same  course  of  teaching. 

The  first  and  second  years  are  devoted  largely  to  the  study  of 
the  structures  and  functions  of  the  normal  body,  and  laboratory 
work  occupies  most  of  the  student's  time  during  these  two  years. 

Some  introductory  instruction  in  Medicine  and  Surgery  is  given 
in  the  second  year.  The  third  and  fourth  years  are  almost  en- 
tirely clinical. 

A  special  feature  of  instruction  in  the  school  is  the  attempt  to 
bring  together  teacher  and  student  in  close  personal  relationship. 
In  many  courses  of  instruction  the  classes  are  divided  into  small 
groups  and  a  large  number  of  teachers  insures  attention  to  the 
needs  of  each  student. 

In  many  courses  the  final  examination  as  the  sole  test  of  pro- 
ficiency has  disappeared  and  the  student's  final  grade  is  deter- 
mined largely  by  partial  examinations,  recitations  and  assigned 
work  carried  on  throughout  the  course. 

DEPARTMENT  OF  ANATOMY,  INCLUDING  HISTOLOGY  AND 
EMBRYOLOGY. 

C.  L.  Davis,  M.D Pi:ofessor  of  Anatomy 

Tllghman  B.  Mabden,  A.B.,  M.D. ..  Prof essor  of  Histology  and  Embryology 

M.  J.  Hanna,  M.D Associate  in  Anatomy 

Howard  B.  McElwain,  M.D Instructor  in  Anatomy 

A.  E.  Goldstein,  M.D Instructor  in  Histology 

First  Year.  Didactic.  Five  hours  each  week  for  thirty-two 
weeks.  Each  day,  preceding  the  laboratory  period,  a  quiz  and 
demonstration  of  from  40  to  50  minutes  is  held,  covering  the  lab- 
oratory work  for  the  day. 

Laboratory.  Eighteen  hours  each  week  for  sixteen  weeks. 
Twelve  hours  each  week  for  sixteen  weeks.  This  course  includes 
a  complete  dissection  of  the  human  body,  including  the  central 
nervous  system.  Abundance  of  good  material  is  furnished  and 
the  student  is  aided  in  his  work  by  competent  demonstrators. 
Practical  examinations  are  held  at  frequent  intervals  throughout 


60  ORGANIZATIOIN"    OF  THE   CURRICULUM 

the  session  and  each  student  will  be  held  to  strict  account  for 
material  furnished  him.  Each  student  is  furnished  a  skeleton  and 
a  deposit  is  required  to  insure  its  return  in  good  condition  at  the 
end  of  the  session. 

Second  Year.  Didactic.  Three  hours  each  week  for  six  weeks. 
Lectures,  recitations  and  conferences. 

Laboratory.  Seven  hours  each  week  for  six  weeks.  This  course 
is  devoted  exclusively  to  Neuro-Anatomy.  A  complete  dissection 
of  the  human  brain  is  required.  This  is  followed  by  a  study  of 
the  fiber  tracts  of  the  spinal  cord  and  brain,  special  models  and 
preparations  being  used  for  this  part  of  the  course. 


,  Histology. 

First  Year.  Lectures,  recitations  and  laboratory  work,  nine 
hours  each  week  during  first  semester;  three  hours  each  week 
during  second  semester.  The  most  important  part  of  the  work 
will  be  done  in  the  laboratory,  where  each  student  will  be  pro- 
vided with  a  microscope,  apparatus,  staining  fluids  and  material 
necessary  for  the  preparation  of  specimens  for  microscopical  ex- 
amination. An  important  aid  to  the  course  is  the  projection 
microscope  which  is  used  for  the  projection  upon  a  screen  of  mag- 
nified images  of  the  specimens  actually  used  in  the  laboratory. 

A  large  number  of  completely  prepared  sections  are  loaned  to 
the  students  for  study.  This  materially  reduces  the  time  other- 
wise required  by  the  student  for  the  preparation  of  sections  and 
insures  the  best  possible  class  of  material  for  study. 


Embryology. 

Lectures,  recitations  and  laboratory  work ;  six  hours  each  week 
during  the  second  semester. 

This  course  includes  the  study  of  the  development  of  the  chick, 
and  the  fundamental  principles  of  mammalian  embryology.  In 
the  laboratory,  the  hen's  egg  will  be  studied  in  its  various  stages 
of  development,  and  sections  of  the  chick  at  different  periods  of 
incubation  will  be  made  and  studied  microscopically.  The  latter 
part  of  the  course  will  be  devoted  to  the  study  of  sections  through 
different  regions  of  a  mammal. 

Special  emphasis  is  laid  upon  tlie  development  in  the  human. 


ORGANIZATION   OF  THE  CUERICULUM  51 

DEPARTMENT  OF  PHYSIOLOGY. 

Baktgis  McGloxNe.  A.B.,  Ph.D.,  F.A.C.P Professor  of  Physiology 

Charles  C.  Consee,  M.D Associate  Professor  of  Physiology 

Hakold  E.  Weight,  M.D Associate  in  Physiology 

FiBMADGE  K.  Nichols,  A.B.,  M.D Instructor  in  Physiology 

The  course  in  Physiology  extends  throughout  the  First  and  Sec- 
ond Years.  It  consists  of  a  series  of  lectures,  covering  the  field  of 
human  physiology,  laboratory  work,  demonstrations,  and  frequent 
recitations.  It  is  constantly  in  the  mind  of  the  department  that 
this  course  is  introductory  to  the  study  of  medicine.  The  recita- 
tions cover  the  subject-matter  of  the  lectures  and  the  experiments 
performed  in  the  laboratory. 

First  Year.  1.  This  course  includes  lectures  and  recitations 
upon  the  physiology  of  the  blood  and  circulation,  respiration, 
muscle  and  nerve,  a  portion  of  the  central  nervous  system,  and 
special  senses,  and  such  chemical  and  physical  facts  as  are  neces- 
sary for  a  proper  understanding  of  the  physiology  taught.  Two 
lectures  and  a  recitation  weekly  throughout  the  year.  Dr.  Mc- 
Glone,  assisted  by  Dr.  Wright. 

Second  Year.  2.  Didactic  instruction.  During  this  year  the 
remaining  topics  of  physiology  are  covered  by  lectures  and  demon- 
strations. As  in  the  first  year  frequent  recitations  will  be  held. 
The  subject-matter  includes  the  physiology  of  digestion  and  secre- 
tion, nutrition,  metabolism,  internal  secretion,  the  central  nerv- 
ous system,  and  the  eye  and  ear.  Lectures,  demonstrations,  and 
recitations,  three  hours  per  week.  Dr.  McGlone,  assisted  by  Dr. 
Conser. 

3.  Experimental  Physiology.  This  is  a  laboratory  course  in  the 
dynamics  of  muscle  and  nerve,  studies  in  circulation  and  respira- 
tion, and  physiology  of  the  special  senses.  Apart  from  the  acqui- 
sition of  the  facts  of  physiology,  the  student  is  taught  to  observe 
accurately,  record  carefully  the  results  of  his  observations,  and 
from  these  results  draw  an  independent  conclusion.  He  is  also 
trained  in  the  use  of  instruments  which  are  of  value  to  him  in  his 
clinical  years.  Three  hours  weekly  throughout  the  year,  Drs. 
McGlone,  Conser  and  Wright. 

4.  Elective  Course  in  Physiological  Technique.  This  course  is 
offered  to  Sophomores.    Three  hours  per  week.    Second  semester. 

5.  Special  Mammulian  Physiology.  This  is  a  laboratory  course 
intended  for  advanced  Laboratory  students  (optional)  who  may 


52  ORGANIZATION  OF  THE  CUEEICULITM 

wish  to  do  special  work  in  this  line  of  physiology.    Hours  to  be 
arranged.    Dr.  McGlone. 

6.  Research  m  Physiology.  Properly  qualified  students  will  be 
admitted  to  the  laboratory,  which  is  well  adapted  for  post  gradu- 
ate study  and  special  research.  Hours  will  be  arranged  to  suit 
individuals.    Dr.  McGlone. 


PHAB3IAC0L0OY  AND  MATERIA  JEEDICA. 

William  Henry  Schultz,  Ph.B.,  PIi.D Professor  of  Pharmacology 

O.  G.  Harxe,  A.B Associate  Professor  of  Pharmacology 

1.  Pharmacology.  Materia  Medica  and  Prescription  Writing 
required  of  all  second  year  medical  students  during  the  first 
semester.  Didactic,  three  hours  a  week ;  Laboratory,  three  hours 
a  week. 

This  course  is  a  prerequisite  to  all  other  courses  in  Pharma- 
cology. Special  emphasis  is  laid  upon  laboratory  methods  of  ob- 
servation and  of  intelligent  note-taking.  The  essentials  of  pre- 
scription writing  are  taught  and  the  student  is  introduced  to  the 
official  pharmacopoeal  preparations. 

Not  only  is  the  student  taught  intelligently  to  use  the  United 
States  Pharmacopea  and  the  National  Formulary,  but  the  princi- 
ples underlying  the  establishing  of  some  of  the  most  practical 
receipts  are  attacked  from  a  didactic  point  of  view. 

2.  Systematic  Pliarmacology.  Kequired  of  all  second  year  medi- 
cal students.  Three  hours  a  week  during  the  year,  two  lecture 
periods  and  one  period  for  quiz  and  general  conferences.  Special 
care  is  taken  to  adapt  the  material  to  the  practical  needs  of  the 
medical  student.  Emphasis,  however,  is  laid  upon  the  pharmaco- 
logical action  of  drugs  as  a  pure  science  in  order  that  a  critical 
attitude  toward  drugs  may  be  instilled.  As  the  student  masters 
the  pharmacology  of  an  important  drug,  its  dosage,  incompatibili- 
ties, and  practical  applications  are  driven  home  by  systematic 
assignments  of  prescription  writing,  quizes,  and  conferences. 

3.  Pharmacodynamics. — Second  semester.  Kequired  of  all  sec- 
ond year  medical  students.  Prerequisite  pharmacology  1.  Lab- 
oratory, six  hours  a  week. 

The  course  runs  parallel  with  pharmacology  2.  Being  a  labora- 
tory course  it  furnishes  much  didactic  material  used  in  the  class 
conferences  and  lectures  of  pharmacology  No.  2. 


ORGANIZATION   OF  THE   CURRICULUM  53 

As  the  student's  ability  in  handling  biological  material  de- 
velops, experiments  involving  the  more  difficult  technic  of  phar- 
macological experimentation  are  introduced.  Special  emphasis  is 
laid  upon  the  student's  ability  to  handle  live  tissues  and  to  make 
first-hand  observations  of  a  given  drug's  action,  regardless  of 
what  standard  text-books  teach. 

Class  conferences,  discussions,  and  the  reading  of  assigned  pa- 
pers are  used  to  supplement  the  laboratory  and  lecture.  In  these 
conferences  the  professor  in  charge  attempts  to  summarize  the 
class  work  as  a  whole,  thereby  properly  coordinating  it.  It  is  by 
these  means  that  the  student  acquires  a  critical  and  scientific  atti- 
tude toward  official  and  new  and  non-official  remedies.  The  study 
is  limited  for  the  most  part  to  such  drugs  as  are  known  to  have  a 
definite  pharmacological  action  and  therapeutic  value. 

4.  Special  Pharmacodynamics.  (Credit  according  to  work  done.) 
This  course  is  open  to  advance  students  and  special  workers 

who  desire  advanced  training,  or  who  wish  to  pursue  some  special 
problem  in  Pharmacology  or  Toxicology.  Hours  to  be  arranged. 
Professor  Schultz. 

5.  Research  in  Pharmacology  and  Chemo-Therapy.  Properly 
qualified  students  are  admitted  to  the  laboratory  with  a  view  to 
their  carrying  on  original  investigations  in  drug  action.  The 
newly  equipped  laboratories  are  well  adapted  for  post-graduate 
study  and  research  in  Pharmacology.  Hours  will  be  arranged  to 
suit  the  applicant.    Professor  Schultz. 


DEPARTMENT  OF  PATHOLOGY. 

Hugh  E.  Spencer,  M.D Professor  of  Pathology 

Standish  McCleary,  M.D '. Professor  of  Pathology 

Sydney  Cone,  M.D Associate  Professor  of  Pathology 

Wm.  J.  Cakson,  M.D Associate  Professor  of  Pathology 

E.  D.  Weinberg,  M.D Assistant  in  Pathology 

A.  E.  Goldstein,  M.D Assistant  in  Pathology 

Courses  of  instruction  in  pathology  are  given  during  the  sec- 
ond, third  and  fourth  years.  The  courses  are  based  on  previous 
study  of  normal  structures  and  functions  and  aim  to  outline  the 
natural  history  of  disease.  The  instruction  is  made  as  practical 
as  possible  that  the  student  may  become  familiar  with  the  appear- 
ance of  organs  and  tissues  in  disease  and  may  be  able  to  correlate 
anatomical  lesions  with  clinical  symptoms  and  signs. 


54  OKGAXIZATION   OF  THE   CUERICULUM 

1.  General  Pathology  and  Histo-pathology.  This  course  is 
given  to  second  year  students,  it  includes  the  study  and  demon- 
stration of  disturbances  of  the  body  fluids,  disturbances  of  struc- 
ture, nutrition  and  metabolism  of  cells,  disturbances  of  fat,  car- 
bohydrate and  protein  metabolism,  disturbances  in  pigment  met- 
abolism, inflammation  and  tumors.  The  laboratory  course  con- 
sists in  a  daily  preliminary  lecture,  after  which  the  student  is 
given  microscopical  sections  for  study.  Gross  material  from 
autopsy  and  from  the  museum  is  demonstrated  in  conjunction 
with  the  microscopical  study. 

2.  Applied  Pathology,  including  Gross  Morbid  Anatomy  and 
Morbid  Physiology.  Third  year  students:  In  this  course  the 
special  relationship  of  the  gross  and  microscopical  lesions  to  clin- 
ical symptoms  and  signs  is  emphasized.  Fresh  material  from 
autopsy  collected  at  the  various  hospitals  is  demonstrated  and 
supplemented  by  a  study  of  the  respective  autopsy  protocols. 

Special  stress  is  laid  upon  the  study  of  the  infectious  diseases 
and  where  possible  the  causative  agents  are  studied. 

3.  Autopsies.  Third  year.  Autopsy  technic  is  taught  to  small 
groups  of  students  by  special  instruction  a+  autopsies  performed 
at  the  various  hospitals.  Students  are  required  to  assist  at  the 
autopsy,  study  the  organs,  examine  the  microscopical  sections, 
make  cultures  and  prepare  autopsy  protocols. 

4.  Clinical  Pathological  Conference.  Fourth  year.  Mate- 
rial from  autopsies  is  studied  with  reference  to  the  clinical  history 
and  gross  and  microscopical  anatomy,  the  course  is  illustrated 
with  sections  of  fixed  material  or  lantern  slides. 

5.  Advanced  Work  in  Pathology.  Properly  qualified  students 
will  be  permitted  to  carry  out  advanced  or  research  work  along 
the  lines  of  experimental  pathology.  Adequate  space  and  equip- 
ment is  available. 

DEPARTMENT  OF  BACTERIOLOGY  AND  IMMUNOLOGY. 

Wm.  Royal  Stokes,  M.D.,  Sc.D Professor  of  Bacteriology 

Fbank  W.  Hachtel,  M.D Associate  Professor  of  Bacteriology 

Louis  F.  Krumrein,  M.D Instructor  in  Bacteriology 

Henby  F.  Btjettnee,  M.D Instructor  in  Bacteriology 

J.  A.  F.  Pfeiffer,  M.D.* Instructor  in  Bacteriology 

Instruction  in  special  bacteriology  is  given  in  the  laboratory  to 
the  students  of  the  first  year  during  one  semester.  This  includes 
the  various  methods  of  sterilization  and  preparation  of  culture 


\ 


ORGANIZATION   OF  THE   CUERICULUIM  55 

material,  the  study  of  pathogenic  microorganisms  of  vegetable 
origin,  and  the  bacteriological  study  of  water,  milk,  sewage,  and 
other  such  materials.  The  bacteriological  diagnosis  of  the  infec- 
tious diseases  is  also  included  in  this  course.  Animal  inocula- 
tions and  autopsies  are  performed  in  connection  with  the  bacteria 
studied  and  diagnoses  by  means  of  serum  reactions  are  also  given. 
In  the  third  year  the  various  animal  parasites  are  demonstrated 
and  the  diseases  produced  by  these  organisms  studied  by  means 
of  gross  specimens,  stained  sections  and  lantern  slides.  The  prin- 
ciples of  general  bacteriology  are  taught  by  lectures  given  twice 
a  week  during  one  semester.  These  lectures  include  the  structure 
of  bacteria,  the  various  facts  concerning  their  biological  proper- 
ties, infection  and  immunity. 

The  general  principles  of  immunology  are  described  in  lectures 
to  the  second  year  class  throughout  the  first  semester  and  prac- 
tical ex])eriments  in  immunology  are  demonstrated  to  this  class 
in  laboratory  sessions  of  three  hours  each,  held  twice  weekly 
throushout  the  first  semester. 


DEPARTMEIVT  OF  BIOLOGICAL  CHEJnSTRY. 

H.  Boyd  Wylie,  M.D Professor  of  Biological  Chemistry 

Frank  X.  Ogden.  M.D Instrvictor  iu  Biological  Chemistry 

Instruction  in  Biological  Chemistry  comprises  laboratory  work, 
lectures  and  conferences. 

Laboratory  Work.  The  first  few  weeks  of  the  laboratory 
work  consists  in  the  preparation  of  normal  and  standard  solu- 
tions which  requires  careful  use  of  the  analytical  balance  and  of 
volumetric  glassware.  The  knowledge  gained  in  this  preliminary 
period  is  then  put  to  practical  application  in  the  making  of  quan- 
titative determinations  of  nitrogenous  compounds  of  known  nitro- 
gen content.  Daily  reports  are  required  of  each  student  in  this 
work  and  a  careful  record  is  kept  of  his  ability. 

At  the  end  of  this  period  there  follows  a  long  course  of  labora- 
tory work  on  the  chemistry  and  metabolism  of  the  carbohydrates, 
proteins  and  lipins.  Each  type  of  foodstuff  is  considered  separ- 
ately; first  its  chemistry  is  studied  and  then  its  metabolism.  In 
following  this  arrangement  the  usual  long  stretch  of  the  pure 
chemistrv  of  all  of  the  foodstuffs  is  eliminated. 


56  ORGANIZATION   OF  THE   CUERICULUM 

Experiments  on  the  tissues  of  the  body  then  follow,  and  pre- 
cede the  tinal  group  of  experiments  on  bile,  milk  and  those  which 
relate  to  the  more  thorough  stud}'  of  blood  and  urine. 

Throughout  the  laboratory  work  the  older  methods  have  been 
excluded,  and  those  tests  which  are  a  duplication  of  the  same 
principle  have  been  reduced  to  a  minimum.  Qualitative  tests  in- 
clude only  those  which  are  representative  and  essential.  A  great 
deal  of  stress  is  laid  ujjon  the  importance  of  quantitative  and 
metabolic  experiments,  so  that  this  type  of  work  constitutes  the 
major  part  of  the  laboratory  experiments  in  this  course. 

Lectures.  The  lectures  precede  or  run  parallel  to  the  labora- 
tory work,  as  far  as  possible.  The  tirst  lectures  deal  with  labora 
tory  technic,  the  chemistry  of  solutions  and  indicators,  osmosis, 
the  chemistry  of  colloids,  catalysis,  reversible  reactions,  the  law 
of  mass  action  and  a  discussion  of  enzymes.  The  lectures  which 
follow  refer  to  the  chemistrj^  and  metabolism  of  carbohydrates, 
proteins  and  lipins.  Relatively  less  time  is  given  to  the  discus- 
sion of  the  chemistry  of  the  various  foodstutfs  and  more  to  the 
discussion  of  their  metabolism.  In  these  lectures  the  funda- 
mental principles  (biological,  physical  and  chemical)  are  em- 
phasized, however,  not  to  the  exclusion  of  the  correlation  of  the 
normal  and  abnormal  metabolism. 

The  final  lectures  relate  to  discussions  of  the  secretions,  includ- 
ing milk,  and  of  the  blood  and  urine,  including  the  metabolism 
of  inorganic  substances,  salts  and  water. 

Conferences.  From  time  to  time  conferences  are  held  for  the 
purpose  of  summarizing  the  work  completed ;  to  discuss  any  prob- 
lems that  have  arisen  during  the  course,  and  to  review  articles 
in  journals  which  have  a  bearing  on  the  current  laboratory  or 
lecture  work. 

During  the  second  semester  sections  are  sent  into  the  hospital 
for  the  purpose  of  collecting  data  on  special  metabolic  or  associ- 
ated conditions.  This  data  will  be  presented  to  the  class  as  a 
whole  and  later  discussed  at  a  special  clinic  conducted  in  the 
hospital  by  a  member  of  the  Department  of  Medicine  in  collabora- 
tion with  this  department. 


CLINICAL   INSTKUCTION 


57 


CLINICAL  INSTRUCTION. 


DEPARTMENT  OF  MEDICINE. 


Maurice  C.  Pincoffs,  S.B.,  M.D Professor  ofMedicine 

Gordon  Wilson,  M.D Professor  of  Medicine 

Caby  B.  Gamble,  Jr.,  A.M..  M.D Professor  of  Medicine 

Standish  McCleary,  M.D ....  Professor  of  Pathology  and  Clinical  Medicine 

Jos.  E.  Gichner,  M.D Professor  of  Clinical  Medicine. 

Charles  W.  McElfresh,  M.D Professor  of  Clinical  Medicine 

G.  Carroll  Lockabd,  M.D Professor  of  Clinical  Medicine 

Harvey  G.  Beck,  M.D.,  Sc.D Professor  of  Clinical  Medicine 

Hubert  C.  Knapp,  M.D Associate  Professor  of  Medicine 

Paul  W.  Clough,  B.S.,  M.D Associate  Professor  of  Medicine 

C.  C.  W.  JuDD,  A.B.,  M.D Associate  Professor  of  Medicine 

Sydney  R.  Miller,  M.D Associate  Professor  of  Medicine 

John  Lutz,  A.B.,  M.D Associate  Professor  of  Medicine 

H.  D.  McCabty,  M.D Associate  Professor  of  Clinical  Medicine 

Wm.  H.  Smith,  M.D Associate  Professor  of  Clinical  Medicine 

H.  J.  Maxdeis,  M.D Associate  Professor  of  Medical  Jurisprudence 

S.  Lloyd  Johnson,  A.B.,  M.D Assistant  Professor  of  Medicine 

R.  C.  Metzel.  M.D Associate  in  Clinical  Medicine 

W.  I.  Messick,  M.D Associate  in  Clinical  Medicine 

George  McLean,  M.D Associate  in  Medicine 

Harry  M.  Stein,  M.D Associate  in  Medicine 

L.  A.  M.  Krause,  M.D Associate  in  Medicine 

E.  E.  Mayer,  M.D Instructor  in  Medicine 

D.  CoRBiN  Streett,  M.D Instructor  in  Medicine 

C.  C.  Habliston,  M.D Instructor  in  Medicine 

Martin  Sloan,  M.D •. Instructor  in  Medicine 

H.  R.  Lickle.  M.D Instructor  in  Medicine 

J.  W.  Marti  ndale,  M.D Instructor  in  Medicine 

C.  R.  Goldsborough.  A.M.,  M.D Instructor  in  Medicine 

Horace  Byers,  M.D Assistant  in  Medicine 

B.  B.  Brumbaugh,  M.D Assistant  in  Medicine 

Herman   Seidel,   M.D Assistant  in  Medicine 

Wetherbee  Fort,  M.D Assistant  in  Medicine 


58  CLINICAL   INSTRUCTION 

GENERAL  OUTLINE. 

Second  Year. 

Introduction  to  clinical  medicine. 

(a)  Introductory  physical  diagnosis. 

(1  hour  a  week,  first  semester.) 
(2  hours  a  week,  second  semester.) 

(b)  Clinical  lectures  on  pathological  physiology. 

(1  hour  a  week,  second  semester.) 

Third  Year. 

I.  The  methods  of  examination  (13  hours  a  week). 

(a)  History  taking. 

(b)  Physical  diagnosis. 

(c)  Clinical  pathology. 

These  sub.iects  are  taught  and  practiced  in   the  out-patient  depart- 
ment and  in  the  clinical  laboratory. 
II.  The  principles  of  medicine   (7  hours  a  week). 

(a)   Lectures,   clinics  and   demonstrations  in   general   medicine,   neu- 
rology, pediatrics  and  preventive  medicine. 
III.  The  principles  of  therapeutics  (2  hours  a  week). 

(a)   Lectures   and    demonstrations   in    general   therapeutics,   physical 
therapeutics  and  materia  medica. 

Fourth  Year. 

The  practice  of  medicine. 
I.  Clinical  clerkship  on  the  medical  wards. 
(26  hours  a  week  for  ten  weeks.) 

(a)  Responsibility,    under    supervision,    for   the  history,   physical  ex- 

amination, laboratory  examinations  and  progress  notes  of  as- 
signed cases. 

(b)  Ward  classes   in  general   medicine,  the   medical   specialties,  and 

therapeutics. 
II.  Clinics   in  general    medicine  and  the  medical    specialties    (6  hours  a 
week). 

III.  Dispensary  work  in  the  medical  specialties. 

IV.  Clinical  pathological  conferences  (1  hour  a  week). 

• 

Medical  Dispensary  Work. 

The  medical  dispensaries  of  both  the  Mercy  and  the  University 
Hospitals  are  utilized  for  teaching  in  the  third  year.  Each  stu- 
dent spends  two  periods  a  week  of  two  hours  each"  in  dispensary 
work.     The  work  is  done  in  groups  of  four  to  six  students  under 


CLINICAL   INSTRUCTION"  59 

an  instructor.  Systematic  history  taking  is  especially  stressed. 
Physical  findings  are  demonstrated.  The  student  becomes  fa- 
miliar with  the  commoner  acute  and  chronic  disease  processes. 


Physical  Diagnosis. 

Second  Yeae.  Didactic  lectures  and  practical  demonstrations 
in  the  medical  topography  and  the  physical  conditions  in  health. 
Instruction  and  practice  in  systematic  physical  examination. 

Third  Year,  The  class  is  divided  into  small  groups,  and  each 
section  receives  instruction  for  four  hours  a  week  for  the  entire 
session  in  the  medical  dispensaries  of  the  hospitals.  The  large 
clinical  material  of  the  dispensaries  and  hospitals  is  utilized  to 
give  each  student  the  opportunity  to  familiarize  himself  with  the 
common  types  of  bodily  structure,  with  the  normal  variations  in 
physical  signs  and  with  thie  physical  signs  of  the  chief  pul- 
monarv.  circulatorv  and  abdominal  diseases. 


Tuberculosis. 

During  the  third  year  in  connection  with  the  instruction  in 
physical  diagnosis  a  practical  course  is  given  twice  weekly  to 
sections  of  the  class  at  the  Municipal  Tuberculosis  Hospital. 
Stress  is  laid  upon  the  recognition  of  the  physical  signs  of  the 
disease,  as  well  as  upon  its  symptomatology  and  gross  pathology. 
.     Dr.  McCartv  and  associates. 


Therapeutics. 

Third  Year.  General  therapeutics  and  materia  medica  are 
taken  up  and  an  effort  is  made  to  familiarize  the  student  with 
the  practical  treatment  of  disease.  The  special  therapy  of  the 
chief  diseases  is  then  reviewed.     Two  hours  a  week.    Dr.  Lockard. 

The  principles  of  physical  therapy  are  taught  in  a  special  lec- 
ture and  demonstration  course  consisting  of  six  one-hour  periods. 
Dr.  Gichner. 

Fourth  Year.  Special  consideration  is  given  to  the  practical 
application  of  therapeutic  principles  in  bedside  teaching  and  the 
chief  therapeutic  methods  are  demonstrated. 


60  CLINICAL   INSTRUCTION 

CLINICAL  PATHOLOGY. 

John  Lutz,  M.D Associate  Professor  of  Medicine 

H.  J.  Maldeis,  M.D Associate  Professor  of  Medical  Jurisprudence 

L.  A.  M.  Krause,  M.D Associate  in  Medicine 

C.  R.  GoLDSBOROUGH,  M.D Instructor  in  Medicine 

During  the  third  year  the  student  is  thoroughly  drilled  in  the 
technique  of  the  usual  clinical  laboratory  work,  so  that  he  is  able 
to  perform  all  routine  examination  which  may  be  called  for  dur- 
ing his  fourth  year,  in  connection  with  the  work  in  the  wards  and 
dispensary. 

The  practical  work  is  supplemented  by  a  series  of  didactic  lec- 
tures and  demonstrations  in  which  the  entire  teaching  staff  of 
the  department  takes  an  active  part.  The  microscopical .  and 
chemical  study  of  blood,  exudates  and  transudates,  gastric  juice, 
spinal  fluid,  feces  and  urine  are  successively  taken  up,  and  spe- 
cial attention  directed  to  the  clinical  significance  of  the  findings. 

Clinical  parasitology-  from  the  standpoint  of  the  infecting  agent 
and  the  carrier,  is  given  careful  consideration. 

The  entire  course  is  thoroughly  practical.  Each  student  is  pro- 
vided with  a  microscope,  blood  counters  and  hemoglobinometer 
for  his  exclusive  use,  and  every  two  students  with  a  special  labor- 
atory outfit  for  all  routine  purposes. 

During  the  fourth  year  the  student  applies  what  he  has  learned 
during  the  preceding  year  in  the  laboratories  of  the  various  affili- 
ated hospitals.  He  is  also  supplied  with  a  laboratory  outfit  which 
is  sufficiently  complete  to  enable  him  to  work  independently  of 
the  general  equipment.  Special  instructors  are  available  during 
certain  hours  to  give  necessary  assistance  and  advice. 

GASTRO-ENTEROLOGT. 

Julius  Friedenwald,  A.M.,  M.D Professor  of  Gastro-Enterology 

T.  Fred.  Leitz,  M.D Clinical  Professor  of  Gastro-Enterology 

J.  Habry  Ullrich,  M.D Associate  in  Gastro-Enterology 

Theodore  H.  Morrison,  M.D Associate  in  Gastro-Enterology 

Maltrice  Feldman Instructor  in  Gastro-Enterology 

Joseph  Sindler,  M.D Assistant  in  Gastro-Enterology 

Z.  Morgan,  M.D Assistant  in  Gastro-Enterology 

M.  S.  Koppelman,  M.D Assistant  in  Gastro-Enteroogy 

M.  Chideckel,  M.D Assistant  in  Gastro-Enterology 

N.  J.  Davidov,  M.D Assistant  in  Gastro-Enteroogy 

Albert  Eisenberg,  M.D Assistant  in  Gastro-Enterology 

Paul  F.  Wiest.  M.D Assistant  in  Gastro-Enterology 


CLINICAL   INSTRUCTION  61 

Fourth  Year.  Clinic  recitations  and  demonstrations  to  the 
class  for  one  hour  a  week  throughout  the  session.  Dispensary 
instruction  to  small  groups  throughout  the  entire  session.  Prac- 
tical instruction  in  the  differential  and  clinical  diagnosis  and 
demonstrations  of  the  newer  methods  of  diagnosis  in  gastro-in- 
testinal  affections. 


PSYCHIATET. 

R.  M.  Chapman,  M.D Professor  of  Psjchiatry 

G.  F.  Sargent,  M.D Associate  in  Clinical  Psychiatry 

Paul  J.  Ewerhardt,  M.D Associate  in  Psychiatry 

George  E.  Clarke,  M.D Associate  in  Psychiatry 

Fourth  Year.  This  subject  is  taught  by  means  of  didactic  and 
clinical  lectures.  Abundant  material  is  at  the  command  of  this 
department  in  the  various  institutions  which  are  presided  over 
by  the  teachers  in  psychiatry.  The  student  is  brought  into  con- 
tact with  the  early  manifestations  of  mental  disease  in  the  dis- 
pensaries of  the  University  and  Mercy  Hospitals,  and  in  a  series 
of  clinics  opportunity  is  afforded  to  observe  the  course  and  later 
manifestations  of  the  disease,  often  in  these  same  patients,  at  the 
Sheppard-Enoch  Pratt  Hospital,  Mount  Hope  Retreat,  and  City 
Detention  Hospital. 


PEDIATRICS. 

John  Ruhrah,  M.D Professor  of  Pediatrics 

Charles  L.  Summers,  M.D Professor  of  Pediatrics 

Edgar  B.  Friedenwald,  M.D Clinical  Professor  of  Pediatrics 

C.  LoRiNG  JosLiN,  M.D Associate  in  Pediatrics 

W.  H.  Ingram,  M.D Instructor  in  Pediatrics 

J.  F.  Hawkins,  M.D Assistant  in  Pediatrics 

Howard  H.  Warner,  M.D Assistant  in  Pediatrics 

John  Houff,  M.D. Assistant  in  Pediatrics 

B.  J.  Ferry,  M.D Assistant  in  Pediatrics 

William  J.  Todd,  M.D Assistant  in  Pediatrics 

John  H.  Traband,  M.D Assistant  in  Pediatrics 

William  F.  Geyer,  M.D Assistant  in  Peidatrics 

George  E.  Wells,  M.D Assistant  in  Pediatrics 

F.  B.  Smith,  M.D Assistant  in  Pediatrics 

P.  Artigiani,  M.D Assistant  in  Pediatrics 

I.  J.  Feingart,  M.D Assistant  in  Pediatrics 


62  CLIXICAL   IXSTKUCTIOX 

Third  Year.  Instruction  during  the  third  year  consists  of  one 
lecture  each  week  in  which  infant  feeding  and  the  most  im- 
portant diseases  of  infancy  and  childhood  are  especially  empha- 
sized.    Drs.  Ruhrah  and  Summers. 

Fourth  Year.  During  this  year  a  weekly  clinical  lecture  is 
given  where  the  character  of  disease  is  fully  demonstrated  and 
the  students  are  afforded  an  opportunity  for  personal  examina- 
tion of  all  cases.  In  addition  ward  classes  are  held  weekly  where 
bedside  instruction  is  given.  A  section  of  the  class  also  works 
daily  in  the  Babies'  and  Children's  Clinic.  This  clinic,  which  is 
under  the  direction  of  Dr.  Summers,  has  an  attendance  of  more 
than  one  thousand  monthly,  and  offers  an  excellent  opportunity 
for  study  and  observation  of  a  wide  variety  of  cases  under  com- 
petent instructors. 

Instruction  is  also  given  in  the  Children's  Dispensary  at  the  I 
Mercy  Hospital. 

NEUROLOGY. 

Irving  J.  Spear,  M.D Professor  of  Neurology 

Andrew  C.  Gnxis,  A.M.,  M.D Professor  of  Neurology 

G.  M.  Settle,  A.B.,  M.D Associate  Professor  of  Neurology 

Benjamin  Pushkin,  M.D Instructor  in  Neurology 

Milton  Levy,  M.D Instructor  in  Neurology 

J.  A.  Skladowsky,  M.D Assistant  in  Neurology 

Third  Year.  Lectures  and  recitations  two  hours  each  week  to 
entire  class  throughout  one  semester.  This  course  comprises  the 
study  of  the  anatomy  and  physiology  of  the  nervous  system,  the 
method  of  neurological  examination,  and  relationship  of  signs 
and  symptoms  to  pathological  conditions.  The  material  at  the 
University  and  Mercy  Hospitals  is  available. 

Clinical  Conference,  one  hour  each  week  to  the  entire  class. 
This  subject  is  taught  at  the  University  and  Mercy  Hospitals.  All 
cases  presented  at  these  clinics  are  carefully  examined ;  complete 
written  records  are  made  by  the  students  who  demonstrate  the 
cases  before  the  class.  These  cases  are  usually  assigned  one  or 
two  weeks  before  they  are  presented,  and  each  student  in  the 
class  must  prepare  one  or  more  cases  during  the  year. 

Ward  Class  Insinicilon.  In  small  sections  at  the  Univer.sity 
and  ]\rercy  Hospitals.  In  these  classes  the  students  come  in  close 
personal  contact  with  the  cases  in  the  wards  under  the  super 
vision  of  the  instructor. 


CLINICAL   INSTRUCTION  63 

Dispensary  Instruction.  Small  sections  are  instructed  in  the 
dispensaries  of  the  University  and  Mercy  Hospitals  four  after- 
noons each  week.  In  this  way  students  are  brought  into  contact 
with  nervous  .diseases  in  their  earlier  as  well  as  later  manifesta- 
tions. 

HYGIENE  AND  PREVENTIVE  MEDICINE. 

C.  Hampson  Jones,  M.D.,  CM Professor  of  Hygiene  and  Public  Health 

Third  Year.  Two  lectures  a  week  throughout  the  session. 
The  lectures  will  encompass  the  fundamental  subjects:  Air, 
Water,  Soil,  Food,  Disposal  of  Wastes,  Communicable  Diseases^ 
State  and  Federal  Public  Health  Laws,  and  Industrial  Diseases. 

MEDICAL  JURISPRUDENCE. 

H.  J.  Maldeis,  M.D. Associate  Professor  of  Medical  Jurisprudence 

Baltimore  City  Post  Mortem  Physician. 

Third  Year.    One  hour  each  week  for  one  semester. 

Inasmuch  as  Medical  Jurisprudence  teaches  the  application  of 
every  branch  of  medical  knowledge  to  the  needs  of  law,  civil  or 
criminal,  this  course  embraces  the  following: — Proceedings  in 
criminal  and  civil  prosecution;  medical  evidence  and  testimony; 
identity  in  its  general  relations ;  sexual  abnormalities ;  personal 
identity ;  impotence  and  sterility ;  rape ;  criminal  abortions ;  signs 
of  death;  wounds  in  their  medico-legal  relations;  death,  natural 
and  homicidal ;  malpractice ;  insanity  and  medico-legal  autopsies. 

DEPART3IENT  OF  SURGERY. 

Arthur  M.  Shipley,  Sc.D.,  M.D Professor  of  Surgerj^ 

Archibald  C.  Harrison,  M.D Professor  of  Surgery 

Alexius  McGlannan,  A.M.,  M.D Professor  of  Surgery 

Joseph  H.  Branham,  M.D Professor  of  Clinical  Surgery 

Nathan  Winslow,  A.M.,   M.D Clinical  Professor  of  Surgery 

Page  Edmunds,  M.D Clinical  Professor  of  Industrial  Surgery 

Walter  D.  Wise,  M.D Clinical  Professor  of  Surgery 

Joseph  W.  Holland,  M.D Clinical  Professor  of  Surgery 

J.  C.  Lumpkin,  M.D Clinical  Professor  of  Surgery 

William  W.  Requardt,  M.D Associate  Professor  of  Surgery 

H.  C.  Blake,  M.D Associate  Professor  of  Clinical  Surgery 

Frank  S.  Lynn.  M.D Associate  Professor  of  Surgery 


64  CLINICAL   INSTRUCTIOISr 

Elliott  H.  Hutchins.  A.M.,  M.D Associate  Professor  of  Surgery 

Thomas  R.  Chambebs,  A.M.,  M.D Associate  Professor  of  Surgery 

R.  W;  LocHER,  M.D.  .Associate  Professor  of  Operative  and  Clinical  Surgery 

E.  H,  Hayward,  M.D Associate  in  Surgery 

Frank  J.  Kirby,  M.D Associate  in  Surgery 

Charles  Reid  Edwards,  M.D Associate  in  Surgery 

F.  L.  Jennings,  M.D Instructor  in  Surgery 

A.  M.  Evans,  M.D Instructor  in  Surgery 

E.  P.  Smith,  M.D Instructor  in  Operative  Surgery 

H.  M.  Foster,  M.D Instructor  in  Surgery 

E.  S.  Johnson,  M.D Instructor  in  Surgery 

F.  X.  Kearney,  M.D Assistant  in  Surgery 

G.  W.  Bowden,  M.D Assistant  in  Surgery 

Dwight  Mohr,  M.D Assistant  in  Surgery 

Amos  Hutchins,  M.D Assistant  in  Surgery 

C.  A.  Reifschneider,  M.D Assistant  in  Surgery 

Wm.  R.  Geraghty.  M.D Assistant  in  Surgery 

S.  Demabco,  M.D Assistant  in  Surgery 

0.  H.  Lloyd,  M.D Assistant  in  Surgery 

Clyde  Marvel,  M.D Assistant  in  Surgery 

EvERARD  Briscoe,  M.D .Assistant  in  Surgery 

1.  O.  RiDGELY,  M.D Assistant  in  Surgery 

H.  B.  McElwain,  M.D Assistant  in  Surgery 

C.  F.  Horine,  M.D Assistant  in  Surgery 

The  teaching  is  in  the  Anatomical  Laboratory  and  the  dispen- 
saries, wards,  clinical  laboratories  and  operating  rooms  of  the 
University  and  Mercy  Hospital,  and  in  the  wards  and  dead-house 
of  the  Municipal  Hospitals  at  Bay  View. 

Instruction  is  given  by  means  of  lectures,  recitations,  dispen- 
sary work,  bedside  instruction,  ward-classes,  and  clinics.  The 
work  begins  in  the  second  year,  and  continues  throughout  the 
third  and  fourth  vears. 


Second  Year. 

Topographic  and  Surgical  Anatomj/,  10  hours  a  week  for  the 
first  semester.  The  course  is  designed  to  bridge  the  gap  between 
anatomy  in  the  abstract,  and  clinical  anatomy  as  applied  to  the 
study  and  practice  of  medicine  and  surgery. 

The  teaching  is  done  in  the  anatomical  laboratory,  and  students 
are  required  to  demonstrate  all  points,  outlines,  and  regions  on 
the  cadaver.  Underlying  regions  are  dissected  when  necessary  to 
bring  out  outlines  and  relation  of  structures.  Didactic  lectures 
two  hours  weekly,  augmented  by  demonstrations  with  specimens, 


CLINICAL   INSTEUCTIOK  65 

charts,  and  cross-sections.  Dr.  Holland,  assisted  by  Drs.  Reif- 
schneider,  Foster,  J.  Mason  Hundley,  Jr.,  and  Eeitzel. 

Surgical  Technique.  The  course  includes  history  taking,  first 
aid  treatment,  demonstration  of  use  of  tourniquet  and  other 
emergency  appliances  and  surgical  dressings,  bandages,  plaster, 
adhesive  plaster,  suture  material,  solutions ;  their  preparation 
and  use. 

It  includes  also  inflammation  and  suppuration,  ulcers,  gan- 
grene, fistulae,  sinuses,  non-operative  therapeusis,  asepsis  and 
antisepsis,  the  study  of  circulatory  and  respiratory  failure,  prep- 
aration of  patients,  dummy  operations  and  written  description  of 
operation,  splints,  bed  frames,  bone  plates,  grafts  and  local  an- 
aesthesia. 

Lectures  and  conferences,  two  hours  a  week  for  one  semester. 
Dr.  Edwards. 

Third  Year. 

General  and  Regional  Surgery.  Principles  of  surgery  and  gen- 
eral surgery,  three  hours  a  week  throughout  the  year  to  the  en- 
tire class,  lectures,  recitations  and  clinics.    Dr.  Shipley. 

The  class  is  divided  into  groups  and  receives  instruction  in  his- 
tory-taking, gross  pathology,  and  surgical  diagnosis — at  the  bed- 
side and  in  the  deadhouse  of  the  Municipal  Hospitals  at  Bay 
View.    Drs.  Shipley  and  Lynn. 

Operative  Surgery.  Instruction  is  given  in  operative  surgery 
upon  the  cadaver  and  on  dogs.  The  class  is  divided  into  sections, 
and  each  section  is  given  practical  and  individual  work  under  the 
supervision  of  the  instructors.  Dr.  Frank  S.  Lynn,  assisted  by 
Drs.  Nathan  Winslow,  Locher,  Hayward,  E.  S.  Johnson,  Edwards, 
Foster,  Eeifschneider,  Geraghty,  Demarco,  Kearney,  Briscoe  and 
Horine, 

Fractures  and  Dislocations.  Twenty-four  hours  to  entire  class. 
This  course  consists  of  instruction  in  the  various  forms  of  frac- 
tures and  dislocations  and  their  treatment,  and  serve  as  a  prepar- 
atory course  for  clinical  work.    Dr.  Wise. 

Surgical  Dispensary.  Under  supervision,  the  student  takes  the 
history,  makes  the  physical  examination,  attempts  the  diagnosis, 
and,  as  far  as  possible,  carries  out  the  treatment  of  the  ambu- 
latory surgical  cases  in  the  University  and  Mercy  Hospitals. 
Mercy  Hospital — Drs.  Amos  Hutchins,  Mohr,  A.  M.  Evans, 
Wheaton,  Kearney,  Lloyd  and   Marvel.     University  Hospital — 


66  CLIiSriCAL    IXSTRUCTION 

Drs.   Holland,    Lynn,   Hayward,   Edwards,   E.    S.   Johnson   and 
Foster. 

Fourth  Year. 

Clinics.  A  weekly  clinic  will  be  given  at  the  Mercy  and  Uni- 
versity Hospitals  to  one-half  the  class  throughout  the  year.  As 
far  as  possible  this  is  a  diagnostic  clinic.  Mercy  Hospital — Drs. 
Harrison  and  McGlannan.     University  Hospital — Dr.  Shipley. 

Surgical  Pathology.  A  weekly  exercise  of  one  hour  at  Mercy 
Hospital  for  one  semester,  at  which  specimens  from  the  operat- 
ing-room and  museum  are  studied  in  the  gross  and  microscopi- 
cally, in  relation  with  the  case  history.    Dr.  McGlannan. 

Industrial  Surgery.  Operative  and  post-operative  treatment 
of  accident  cases,  with  instructions  as  to  the  relationship  between 
the  state,  the  employee,  and  employer,  and  the  physician's  duty  to 
each.  One  hour  a  week  to  sections  of  the  class  throughout  the 
year.    Dr.  Edmunds. 

Clinical  Clerkship.  The  personal  study  of  assigned  hospital 
patients,  under  supervision  of  the  staffs  of  University  and  Mercy 
Hospitals,  history  taking,  and  physical  examinations  of  patients, 
laboratory  examinations,  attendance  at  operations  and  observa- 
tion of  post-operative  treatment. 

Ward  Classes.  Ward  class  instruction  in  small  groups,  will 
consist  of  ward  rounds,  surgical  diagnosis,  treatment  and  the 
after  care  of  operative  cases.  Mercy  Hospital — Drs.  Harrison, 
McGlannan,  Wise,  Elliott  Hutchins,  Evans  and  Locher.  Univer- 
sity— Drs.  Shipley,  Holland,  Edmunds.  Lynn  and  Edwards. 

ANAESTHESIA. 

Third  Year. 

Lectures  on  the  history  of  anaesthesia,  general  physiology  of 
inhalation  of  anaesthetics,  special  physiology  of  each  anaesthetic, 
methods  of  administration,  inhalation,  colonic,  intravenous,  com- 
plications and  preventive  methods,  including  artificial  respiration 
and  post-anaesthesia  treatment  of  patients.  One  hour  weekly  for^ 
one  semester.    Dr.  S.  Griffith  Davis. 

Anaesthesia  in  obstetrics,  one  lecture.    Dr.  J.  McF.  Bergland. 

Fourth  Year. 

During  the  clinics  and  operations  before  small  groups,  each  stu- 
dent will  be  required  to  administer  anaesthetic  under  the  direc- 


CLINICAi    INSTRUCTION  .  67 

lion   of   an   instructor.     University   Hospital — Drs.   Queen   and 
Moore.     Mercy  Hospital — ^Drs.  Kearney  and  Eidgely. 

DERMATOLOGY. 

T,  Caspar  Gilchrist,  M.R.C.S.,  L.S.A.,  M.D Professor  of  Dermatology 

Melvin  Rosenthal,  M.D Associate  Professor  of  Dermatology 

John  R.  Abercrombie,  A.B.,  J.D Associate  Professor  of  Dermatology 

Harry  M.  Robinson,  M.D Associate  in  Dermatology 

Joseph  E.  Gately,  M.D Instructor  in  Dermatology 

JouN  A.  Buchness,  M.D Assistant  in  Dermatology 

Clinical  conference  one  hour  each  week  to  entire  class.  This 
course  will  consist  of  demonstrations  of  the  common  diseases  of 
the  skin.     Dr.  Gilchrist. 

Dispensary  instruction,  University  Hospital,  Mondays,  Wednes- 
days and  Fridays  in  the  diagnosis  and  treatment  of  the  common 
skin  diseases.  Dr.  Abercrombie.  Dispensary  instruction,  Mercy 
Hospital,  Drs.  Kosenthal,  Robinson  and  Gately. 

ORTHOPAEDIC  SURGERY. 

R.  TuNSTALL  Taylor,  A.B.,  M.D Professor  of  Orthopedic  Surgery 

Albertus  Cotton,  A.M.,  M.D Professor  of  Orthopedic  Surgery 

CoMPTON  Riely,  M.D Clinical  Professor  of  Orthopedic  Surgery 

W.  H.  Daniels,  M.D Demonstrator  in  Orthopedic  Surgery 

W.  Arthur  Darby,  M.D Demonstrator  in  Orthopedic  Surgery 

H.  L.  Wheeler,  M.D Demonstrator  in  Orthopedic  Surgery 

In  this  course  didactic,  clinical,  bedside  and  out-patient  instruc- 
tion will  be  given.  This  instruction  is  provided  in  the  University 
Hospital  Amphitheater  and  Dispensary,  Mercy  Hospital  and  Dis- 
pensary and  Kernan  Hospital  and  Industrial  School  for  Crippled 
Children  at  "Radnor  Park,"  and  in  the  Dispensary  of  same  at 
620  West  Lombard  Street. 

Lectures,  clinics  and  quizzes  will  be  held  at  each  of  the  hospi- 
tals once  a  week.  In  addition,  a  weekly  bedside  clinic  will  be  held 
for  sinal^  sections  of  the  class  at  ''Radnor  Park." 

The  course  will  cover  instruction  in  special  methods  and  in- 
struments required  in  this  surgical  specialty,  including  X-Ray 
tfchnique;  Wolff's  law;  tuberculosis  of  bones  and  joints;  defor- 
mities of  the  feet;  non-tuberculous  deformities  of  the  feet  and 
joints;  the  paralyses;  the  bursal,  tendinous  and  muscular  condi- 
tions producing  orthopedic  affections;  rickets;  scurvy;  osteoma- 


68  CLINICAX  INSTRUCTION 

lacia:  chondrodystrophies;  wry-neck  and  the  use  and  application 
of  orthopedic  apparatus. 

ROENTGENOLOGY  AND  RADIOTHERAPY. 

Henry  J.  Wajltox,  M.D Professor  of  Roentgenology 

Albertus  Cotton,  A.M.,  M.D Professor  of  Roentgenology 

John  Evans,  M.D Associate  Professor  of  Roentgenology 

Charles  Reid  Edwards.  A.B.,  M.D Associate  in  Radio  Therapy 

tnstruction  is  given  in  the  history,  physics,  and  practical  ap- 
plication of  Eoentgen  Eays  and  Kadium.  Especial  effort  is  made 
tu  demonstrate  the  use  of  the  Eoentgen  Eay  in  diagnosis  by  in- 
struction in  both  fluoroscopy  and  plate  reading.  The  sections  of 
the  fourth  year  class  receive  two  hours  instruction  each  week. 

'J'he  student  is  also  taught  the  practice,  application  of  Eadium 
and  Eoentgen  rays  as  therapeutic  agents.  In  the  X-ray  labora- 
tory and  in  the  hospital  wards  students  are  shown  the  use  of  these 
agents  in  Ihe  treatment  of  disease. 

DISEASES  OF  THE  THROAT  AND  NOSE. 

Edward  A.  Looper,  M.D., 

Clinical  Professor  of  Diseases  of  the  Throat  and  Nose 
Frank  Dyer  Sangeb,  M.D. . .  .Professor  of  Diseases  of  the  Throat  and  Nose 
George  W.  Mitchell,  M.D., 

Associate  Professor  of  Diseases  of  the  Throat  and  Nose 
George  Murgatroyd,  M.D. . .  .Associate  in  Diseases  of  the  Throat  and  Nose 

W.  F.  Quinn,  M.D Associate  in  Diseases  of  the  Throat  and  Nose 

Frank  B.  Anderson,  M.D. .  .Instructor  in  Diseases  of  the  Throat  and  Nose 
R.  F.  McKenzie,  M.D Assistant  in  Diseases  of  the  Throat  and  Nose 

TiiiuD  Year.  Clinical  Lectures.  One  hour  each  week  through- 
cur  the  session.    Drs.  Looper  and  Sanger. 

FoiRTH  Year.  Dispensary  instruction  daily  in  small  sections 
at  the  University  and  Mercy  Hospitals.  Ward  classes  one  hour 
each  week  at  the  L'niversity  and  Mercy  Hospitals. 

GENITO-URINARY  DISEASES. 

Anton  G.  Rytina,  A.B..  M.D Professor  of  Genito-Urinary  Diseases 

Harris  Goldman,  M.D Associate  in  Genito-Urinary  Diseases 

W.  H.  TouLsoN,  M.D Associate  in  Genito-Urinary  Diseases 

A.  J.  Gnxis,  M.D Instructor  in  Genito-Urinary  Diseases 

WiLFORD  A.  Councell,  M.D Instructor  in  Genito-Urinary  Diseases 


CLINICAL,   INSTRUCTION  69 

Amos  F.  Hutchins,  M.D Assistant  in  Genito-Urinary  Diseases 

L.  K.  Fargo,  M.D Assistant  in  Genito-Urinary  Diseases 

Austin  H.  Wood,  M.D Assistant  in  Genito-Urinary  Diseases 

Howard  L.  Tolson,  M.D Assistant  in  Genito-Urinary  Diseases 

Instruction  in  Genito-Urinary  Surgery  is  given  to  the  members 
€f  the  senior  class,  from  both  a  practical  and  didactic  standpoint. 
The  course  includes  everything  pertaining  to  modern  urology, 
such  as  urethroscopy,  cystoscopy,  ureter  catheterization,  renal 
functional  tests,  X-ray,  pyelography,  blood  urea  estimations,  etc. 
The  teaching  consists  of  clinics  in  the  amphitheatre,  ward  rounds, 
and  attendance  by  members  of  the  senior  class  upon  out-patients 
in  the  dispensary.  In  the  latter  department  there  were  about 
30,000  visits  made  during  the  past  year.  Ample  facilities  are 
afforded  the  students  to  see  a  large  variety  of  every  type  of 
venereal  disease.  They  are  first  instructed  in  the  method  of  tak- 
ing a  genitourinary  history,  are  shown  the  technique  of  ure- 
throscopy, cystoscopy,  urethral  instrumentation,  rectal  massage, 
demonstrations  of  the  spirocheta  pallida,  and  administration  of 
Salvarsan. 

DISEASES  OF  THE  COLON  AND  RECTUM. 

G.  Milton  Linthictjm,  A.M.,  M.D., 

Professor  of  Diseases  of  Rectum  and  Colon 

Charles  F.  Blake,  M.D Professor  of  Diseases  of  Rectum  and  Colon 

J.  Dawson  Reeder,  M.D., 

Associate  Professor  of  Diseases  of  Rectum  and  Colon 

I 

FouiiTH  Yi:ar.  This  course  is  for  instruction  in  diseases  of  the 
Colon,  Sigmoid  Flexture,  Rectum  and  Anus,  and  will  cover  the 
essential  features  of  the  Anatomy  and  Physiology  of  the  large 
intestine,  as  well  as  the  various  diseases  to  which  it  is  sub- 
ject. The  importance  of  diseased  conditions  and  malpositions  of 
the  intestines,  in  relation  to  systemic  disturbances,  will  be  empha- 
sized by  demonstrations. 

In  small  groups,  the  students  will  be  taken  into  the  wards  and 
dispensaries  of  the  University  and  Mercy  Hospitals,  where  differ- 
ent phases  of  the  various  diseases  will  be  taught  by  direct  obser- 
Vc'tion  and  examination.  The  use  of  the  proctoscope  and  sigmoi- 
doscope in  examination  of  the  rectum  and  sigmoid  will  be  made 
familiar  to  each  student. 

A  cours?'  in  Proctoscopy  may  be  given  in  the  City  Hospitals  at 
Bav  View,  where  abundance  of  material  is  always  obtainable 


70  CLINICAL  INSTRUCTION 

DEPARTMENT  OF  OBSTETRICS. 

J.  M.  H.  Rowland,  M.D Professor  of  Obstetrics 

L.  E.  Neale,  A.m.,  M.D.,  LL.D Professor  of  Obstetrics 

Bernard  Purcell  Muse,  M.D Professor  of  Clinical  Obstetrics 

Charles  E.  Brack.  M.D Clinical  Professor  of  Obstetrics 

J.  McF.  Bergland Associate  in  Obstetrics 

H.  S.  GoRSUCH,  M.D Associate  in  Obstetrics 

L.  H.  Douglass.  M.D Associate  iu  Obstetrics 

F.  H.  Machin,  M.D Assistant  in  Obsterics 

J.  G.  M.  Reese,  M.D Assistant  in  Obstetrics 

Susanne  R.  Parsons,  A.M.,  M.D.,  Ph.D Assistant  in  Obstetrics 

Dudley  Pleasants  Bower,  B.A.,  M.D Assistant  in  Obstetrics 

Stanley  W.  Matthews,  M.D Assistant  in  Obstetrics 

Third  Year.  Three  lectures  and  recitations  each  week  by 
Drs.  Keale  and  Kowland  to  entire  class. 

Manikin  Work.  Drs.  Brack  and  Douglass,  to  sections  of  class 
at  Mercy  and  University  Hospitals. 

Fourth  Year.  Clinical  Conference.  One  hour  each  week  for 
one  semester  to  University  Hospital  section.  Drs.  Eowland  and 
Neale. 

Ward  Classes.  Six  hours  peT  week  for  live  weeks  to  section  of 
class  at  University  Hospital.    Drs.  Kowland  and  Douglass. 


DEPARTMENT  OF  GYNECOLOGY. 

William  S.  Gabdneb,  M.D Professor  of  Gynecology 

J.  Mason  Hundley,  M.D Professor  of  Clinical  Gynecology 

W.  B.  Perry,  M.D Professor  of  Clinical  Gynecology 

Hugh  Erent,  M.D Associate  Professor  of  Gynecology 

Abraham  Samuels,  M.D Associate  Professor  of  Gynecology 

Geo.  a.  Strauss,  M.D Associate  in  Gynecology 

R.  G.  WiLLSE,  M.D Associate  in  Gynecology 

T.  K.  Galvin,  M.D Assistant  in  Gynecology 

Jack  M.  Hundley,  M.D Assistant  in  Gynecology 

Third  Y'ear.  Didactic  Work.  A  course  of  thirty  lectures  and 
recitations  in  the  second  semester. 

Clinical  Work.  Six  hours  weekly  for  one  trimester.  In  this 
course  a  student  writes  the  clinical  history  of  each  patient  in  the 
ward,  makes  a  general  physical  examination,  including  the  blood 
and  urine,  before  the  patient  is  brought  before  the  class.     One 


CLINICAL  IJSTSTEUCTIOISr  Yl 

student  under  supervision  gives  the  anesthetic,  a  pelvic  examina- 
tion is  made  by  six  students,  and  any  operation  required  is  then 
done  before  a  section  of  the  class  small  enough  to  see  clearly  what 
is  being  done  and  how  it  is  done.  On  a  subsequent  day  the  whole 
group  examine  microscopically  sections  prepared  from  material 
removed  from  patients  that  have  been  before  them. 


DEPARTMENT  OF  OPHTHALMOLOGY  AND  OTOLOGY. 

Harry  Friedenwald,  A.B..  M.D . . .  Prof essor  of  Ophthalmology  and  Otology 

J.  W.  Downey,  M.D Clinical  Professor  of  Otology 

Clyde  A.  Clapp.  M.D Associate  Professor  of  Ophthalmology 

M.  Randolph  Kahn,  M.D Associate  Professor  of  Ophthalmology 

H.  K.  Fleck.  M.D Associate  in  Ophthalmology 

Joseph  I.  Kemler.  M.D Associate  in  Ophthalmology 

E.  A.  Knorr,  M.D Asssociate  in  Ophthalmology 

Third  Year.  Course  in  Diseases  of  the  Eye,  October  2nd  to 
January  18th,     Dr.  Harry  Friedenwald. 

Course  in  the  Diseases  of  the  Ear,  October  2nd  to  January 
18th.    Dr.  Downey. 

Practical  Course  in  0 phthalmoscopy .  once  weekly,  in  sections. 
Drs.  Fleck  and  Kemler. 

Fourth  Year.  Clinics  in  Diseases  of  the  Eye  and  Ear,  weekly. 
Drs.  Harry  Friedenwald  and  Downey. 

Ward  Studies  of  ocular  and  aural  lesions  associated  with  gen- 
eral medical  diseases,  once  weekly  in  sections.  Drs.  Clapp  and 
Downey. 

Dispensary  Instruction,  daily  in  small  sections.  Drs.  Kahn 
and  Knorr. 

The  courses  in  Ophthalmology  and  Otology  are  designed  to 
familiarize  the  students  with  the  common  diseases  of  the  eye  and 
ear,  their  recognition  and  treatment,  with  a  view  to  meet  the 
needs  of  the  general  practitioner.  Special  emphasis  is  laid  upon 
the  relation  between  diseases  of  the  eye  and  the  ear  and  systemic 
diseases  and  diseases  of  other  org^ans. 


72 


SCHEDULE 


FIEST  YEAB   SCHEDULE — FIRST    SEMESTER. 


Hours. 

Monday. 

Tuesday. 

Wednesday 

Thursday. 

Friday. 

Saturday. 

A.  M. 
9  to  10. 

1                                             ■! 

Histology  and  Embryology  Laboratory. 

Histology. 

10  to  11. 

Embryology. 

11  to 
11.30. 

Transfer. 

Histology. 

Transfer. 

Histology  and 
Embryology 
Laboratory. 

Transfer. 

Dissecting. 

11.30  to 
12. 

11.30  to  12.30. 
Physiology. 

11.30  to  12.30. 
Physiology. 

11.30  to  12.30. 
Physiology. 

P.  M. 
12  to  1 

Lunch  and 
Transfer. 

Lunch  and 
Transfer. 

Lunch. 

Lunch. 

Lunch. 

1  to  2. 

2  to  5. 

Anatomy 

and                               Dissecting. 

Classes 
classes  at 


in   Anatomy,    Dissecting,    and   Physiology    at   Lombard    and   Greene   Streets;    all   other 
Calvert  and   Saratoga   Streets. 


FIRST  YEAS   SCHEDULE— SECOND    SEMESTER, 


Hours. 

Monday. 

Tuesday. 

Wednesday 

Thursday. 

Friday. 

Saturday. 

A.  M. 

8.30  to 

9.30. 

Histology  and  Embryology  Laboratory. 

Bacteriology 

9.30  to 
10.30. 

Embryology. 

Dissecting. 

10.30  to 
11.30. 

Physiology.          Histology 

Physiology. 

Bacteriology 

Physiology. 

11.30  to 
12.00. 

Lunch. 

P.  M. 
12  to  2. 

Bacteriology.                                              Laboratory. 

2  to  2.30. 

Transfer. 

2.30  to 
5.30. 

Anatomy                               and                               Dissecting. 

Classes 
Calvert  and 


in    Anatomy    and    Dissecting,  at   Lombard   and   Oreene   Streets;  all   other   classes  at 
Saratoga   Sts. 


SECOND  YEAR 

SCHEDULE 
SCHEDULE— FIRST  SEMESTER. 

73 

Hours. 

Monday. 

Tuesday. 

Wednesday. 

Thursday! 

Friday. 

Saturday. 

A.  M. 

8.30   to 
9.30. 

Physiology. 

Laboratory . 

Physiology, 
Section  A. 

Biological 
Chemistry, 
Section  B. 

Physiology. 

Laboratory. 

Physiology, 
Section  B. 

Biological 
Chemistry, 
Section  A. 

Pharmacology. 

Physiology. 

9.30  to 
10.30. 

Biological 
Chemistry. 

Biological 
Chemistry. 

Biological 
Chemistry. 

Pharmacology 

10.30  to 
11.30. 

Pathology. 

Pharmacology 

Pathology. 

Pathology. 

11.30  to           .,         ^ 
12.30.             Lunch. 

Lunch  and  Transfer  Period. 

P.  M. 

12.30  to 
1.30. 

Laboratory. 
Pharmacology 

Laboratory. 

Immunology 
and    Serology 

Laboratory. 

Immunology 
and  Serology 

Immunology. 

Immunology. 

1.30   to 
2.30. 

Surgery. 

Medicine. 

2.30  to 
3.30. 

Surgical 
Anatomy. 

Surgical 
Anatomy. 

3.30  to 
4.30. 

Neural 

Surgical 
Anatomy. 

Ei 

Surgical 
Anatomy. 

4.30   to 
5.30 

Anatomy. 

Classes   on  Tuesdays,   Wednesdays,   Thursdays  and  Fridays    from    12.30    to    5.30,    at    Calvert 
and   Saratoga    Streets;    all   other   classes    at   Lombard    and  Greene  Streets. 


SECOND   YEAR   SCHEDULE— SECOND    SEMESTER. 


A.  M. 

8.30  to       Physiology. 
9.30. 

Laboratory: 
Physiology, 
Section  A. 
Biological 
Chemistry, 
Section   B. 

Physiology. 

Laboratory: 
Physiology, 
Section   B. 
Biological 
Chemistry, 
Section  A. 

Pharmacology 

Physiology. 

9.30  to        Biological 
10.30.         Chemistry. 

Biological 
Chemstry. 

Biological 
Chemstry. 

Pharmacology 

10.30  to  1     ^  ,^   , 
11.30     1     Pathology. 

1 

Pharmacology 

Pathology. 

Pathology. 

ll^O^tO 

Lunch. 

P.  M. 
12  to  1. 

Pathological   Laboratory. 

Medical  Clinic 

1  to  2. 

Surgery. 

2  to  3. 

Laboratory: 
Pharmacology 
Section  A. 
Biological 
Chemistry, 
Section  B. 

Laboratory: 
Pharmacology 
Section  A. 
Physiology, 
Section    B. 

Physical 
Diagnosis. 

Laboratory : 

Pharmacology 

Section    B. 

Physiology. 
Section  A. 

Laboratory: 
Pharmacology 
Section    B. 
Biological 
Chemstry. 
Section  A. 

3  to  4. 

4  to  5. 

All   classes  at  Lombard  and  Greene  Streets. 


74 


SCHEDULE 


THIRD   YEAE   SCHEDULE. 


Hours. 

Monday. 

Tuesday. 

Wednesday 

Thursday. 

Friday. 

Saturday. 

A.  M. 
8.30  to 

Medicine. 

Pathology. 

Therapeutics. 

Surgery. 

Pathology. 

Surgery. 

9.30. 

9.30  to 

10.30 

Pediatrics. 

Surgery. 

Obstetrics. 

Medicine. 

Therapeutics. 

Medicine. 

Physical. 

Physical 

Physical 

Physical 

Physical 

Physical 

Diagnosis. 

Diagnosis. 

Diagnosis. 

Diagnosis. 

Diagnosis 

Diajrnosis 

10.30. 

, 

Operative 

Operative 

Operative 

Operative 

Operative 

Ojierdtive 

to 

Surgery. 

Surgery. 

Surgery. 

Surgery. 

Surgery. 

Siirg'ery. 

1.30. 

Dispensary. 

Dispensary. 

Dispensary. 

Dispensary. 

Dispensary. 

Dispensary. 

Lunch  and 

Lunch  and 

Lunch  and 

Lunch  and 

Lunch  and 

Lunch   and 

Transfer. 

Transfer. 

Transfer. 

Transfer. 

Transfer. 

Transfer. 

P.  M. 
1.30 

Medical 

Obstetrics. 

to 

Clinic. 

Dbstetrics 

Neurology 

Gynecology. 

2.30. 

Section  A. 
Clinical 
Medicine 

2.30 

Pathology 

Pathology. 

Clinical 

Olinical 

Section  B. 

to 

&  Surgery, 

Pathology 

Pathology 

Clinical 

4.30 

Laboratory 

Laboratory. 

Gross 

Pathology, 

at  Bay  View. 

Laboratory 

Laboratory 

Medicine 

&  Surgery, 

Gross 

Eye    &    Ear — 

Eye   &   Ear — 

Oct.  2  to 

Oct.  2  to 

Pathology, 

Jan.  18. 

Section  B. 

Jan. 18. 

at  Bav  View, 

4.30 

Physical 

1.30  to  2.30, 

Physical 

Preventive 

Therapeu- 

Group 

Therapeu- 

Preventive 

Section  A. 

to 

Medicine. 

tics — Jan. 

Work  in 

tics — Jan. 

Medicine. 

1.30   to  2.30, 

22-Feb.  22. 

Ophthalmo- 

22-Feb. 22. 

Group 

5.30. 

Fractures — 
Feb.  26- 
May  31. 

scopy. 

Fractures — 
Feb. 26- 
May  31. 

Work  in 
Ophthalmo- 
scopy. 

From  10.30  A.   M.  to  1.30  P.  M.  the  class   is  divided  into  two  sections,  one  section  reporting 
at  Calvert  and  Saratoga  Streets,  the  other  at  Lombard  and  Greene  Streets. 

Classes    on    Thursdays,    Fridays,  from    1.30    to    5.30,    and    Saturdays,  1.30   to   2.30,   at  Cal- 
vert and   Saratoga   Streets. 


SCHEDULE 

75 

FOURTH  YEAB  SCHEDULE. 

Hours. 

Monday. 

Tuesday. 

Wednesday 

Thursday. 

Friday. 

'     Saturday. 

Ward    Classes 

Ward    Classes 

Ward    ClassesWard    Classes 

Ward    Classes 

Ward    Classes 

A.  M. 

8.30 

Medicine, 

Medicine, 

Medicine,         '  Medicine, 

Medicine, 

Medicine, 

to 

Surgery, 

Surgery, 

Obstetrics.       i  Surgery 

Surgery, 

Surgery, 

H.OO. 

Obstetrics. 

Gynecology. 

Surgery,  10-      Gynecology. 
11- 

Gynecology. 

Medical 

11.00 

Orthopedic 

Clinic 
(University) 

r.  <^''°i<=«'    ,  1       Surgical 
Pathological  !         Clinic 
Conference. 

Medical 

Pediatrics 

12.00. 

Surgery. 

Surgical 
Path. 

Clinic. 

Clinic. 

(Mercy) 

P.  M. 
12  00 

Dispensary 

Dispensary 

Dispensary    |    Dispensary 

Dispensary, 

Dispensary 

to 
2.00. 

Lunch  and 

and 

and  Lunch    [           and 

Lunch  and 

Lunch 

Transfer 

Lunch 

and  Transfer           Lunch 

Transfer. 

and  Transfer. 

GenitoUri- 

2.00 

Deijma)tology 

Eye  and  Ear  |    nary   Clinic 

Gastro- 

Psvchiatry 

Clinic 

Neurology 

Clinic         i       (Mercy) 

Enterology 

Clinic 

to 

(Full  class  at 

Clinic 

(Full  class  at  1     Obstetrical 

Clinic. 

(Full  class  at 

3.00. 

Univ.  Hosp.> 

Univ.  Hosp.)       Clinic   (Uni- 
versity Hosp.) 

(Full  class  at 
Univ.  Hosp.) 

Univ.  Hosp.) 

Ward  Classes 

Ward  Classes 

Ward  Classes    Ward  Classes 

3.00  to 

Medicine.            Medicine. 

Ward  Classes 

Medicine. 

Medicine. 

Nose  &             Orthopedic 

Medicine. 

4.80. 

Urology. 

Proctology. 

Throat.               Surgery. 

X-Kay. 

Eye  &  Ear. 

Pediatrics. 

Obstetrics.         Obstetrics. 

Neurology. 

4.30  to 

Preventive 

Preventive 

5.30. 

Medicine. 

Gynecology. 

Medicine. 

The  Senior  class  is  divided  into  two  sections,  which  report,  one  at  Lombard  and  Greene 
Streets,  the  other  at  Calvert  and  Saratoga  Streets,  for  one  semester  each,  rotate  at  the  end  of 
the  first  semester  on  January  28,  1923. 

Each  section  of  the  class  is  divided  into  three  groups — Medical,  Surgical  and  Special.  These 
•groups  will  rotate  on  the  following  dates: 

SECOND   SEMESTER. 
1st  period,  Jan.  29  to  Mar.  3. 


FIRST  SEMESTER. 
1st  period,   Oct.  2  to  Nov.  4. 


2nd  period,  Nov.  6  to  Dec.  9. 
3rd  period,  Dec.  10  to  Jan.  27. 


2nd  period,  Mar.  5  to  Apr.  7. 
3rd  period,  Apr.  9  to  May  26. 


76       THE  UNIVERSITY  HOSPITAL,  TRAINING  SCHOOL  FOR  NURSES 

THE  UNIVERSITY  HOSPITAL  TRAINING  SCHOOL  FOR 

NURSES. 

Miss  Anxie  Crighton,  R.N.,  Superintendent  of  Training  School. 

The  University  of  Maryland  School  for  Nurses,  established  in 
the  year  1889  for  the  purpose  of  instructing  women  in  the  art  of 
caring  for  the  sick,  is  now  entering  its  thirty-second  year. 

The  University  Hospital  is  a  large  general  hospital  containing 
about  250  beds,  and  is  equipped  to  give  young  women  a  thorough 
course  of  instruction  and  practice  in  all  phases  of  nursing  work. 

Unusual  advantages  are  offered  to  student  nurses  because  of 
the  varied  services  and  well-thought-out  curriculum,  taught  by 
qualified  instructors  and  members  of  the  Medical  Staff  of  the  Uni- 
versity. 

The  Nurses'  Home  is  a  new  fireproof,  modern  building  in  every 
respect ;  single  rooms  for  students,  large  reception  and  recreation 
rooms.  The  Laboratory  and  class  rooms  are  also  in  this  building 
and  have  been  specially  planned  to  answer  the  teaching  needs  of 
the  student  nurse. 

Candidates  wishing  to  obtain  the  course  of  instruction  must 
apply  personally  or  by  letter  to  the  Superintendent  of  Nurses. 
Those  applying  by  letter  should  enclose  a  statement  from  a  clergy- 
man testifying  to  good  moral  character,  and  one  from  a  physician 
certifying  to  sound  health  and  unimpaired  faculties.  No  candi- 
date will  be  considered  who  is  not  physically  fit.  Applicants  must 
not  be  under  19  or  over  35  years  of  .age.  They  must  show  that 
they  have  graduated  from  a  high  school  or  have  the  equivalent  of 
such  a  degree  of  education.  The  Superintendent  of  Nurses  de- 
cides as  to  the  fitness  of  the  candidate  for  the  work  and  the  pro- 
priety of  dismissing  or  retaining  them  at  the  end  of  their  pro- 
bation term.  She  may  also,  with  the  approval  of  the  Committee, 
dismiss  a  pupil  from  the  school  at  any  time  for  misconduct  or 
inefficiency. 

The  course  of  instruction  covers  a  period  of  three  years. 

Classes  are  admitted  in  February  and  March  and  September. 
Student  Nurses  are  on  duty  eight  hours  during  the  day,  and  ten 
hours  when  on  night  duty,  except  during  the  first  six  weeks  of 
the  preliminary  period,  when  four  hours  are  spent  in  the  wards 
and  four  hours  in  the  classroom. 

When  the  work  will  permit  a  half  day  is  allowed  on  "Sunday. 
The  term  of  niorht  dutv  is  two  months  during  each  vear. 


THE   MEECY  HOSPITAL  TEAIISTING  SCHOOL  FOR  I^URSES  77 

Sickness:  Pupils  when  ill  will  be  cared  for  gratutiously.  All 
time  lost  for  sickness  or  anj'  other  canse  must  be  made  up. 
Should  the  authorities  of  the  school  decide  that  through  the  time 
lost  the  theoretical  work  has  not  been  sufficiently  covered  to  per- 
mit the  student  to  continue  in  that  year,  it  will  be  necessary  for 
her  to  continue  her  work  with  the  next  class. 

Vacations :  Vacations  are  given  between  June  and  September. 
A  period  of  three  weeks  is  allowed  the  student  after  the  comple- 
tion of  the  first  and  second  years. 

Examinations :  Examinations  are  held  after  each  course  of 
study  and  lectures,  and  the  standing  of  the  student  at  the  end 
of  the  year  is  based  upon  the  results  of  these  examinations  and 
the  general  character  of  the  work  throughout  the  year. 

The  diploma  of  the  school  will  be  awarded  to  those  who  have 
satisfactorily  completed  the  full  term  of  three  years  and  have 
passed  successfully  the  final  examinations. 


GRADUATING    CLASS    OF    1922,    UNIVERSITY    HOSPITAL. 

student  Address 

Cecile  Marie  DuBois ....'. Maryland 

Veronica    Ellen    Callaghan Ohio. 

Nettle  Bradley  Lord Maryland 

Mary   Julia   Deputy •  ■ Maryland 

Grace  Lovell  Elgin •  • Maryland 

Frankie  Bowman  Morrison Pennsylvania 

Lucile  Love  Bowie •  • Virginia 

Isabelle  Jamison  Pannair Virginia 

Eva   Louise    Yeager •  • Maryland 

THE  MERCY  HOSPITAL  TRAINING  SCHOOL  FOR  NURSES. 

The  Mercy  Hospital  Training  School  for  Nurses,  conducted  by 
the  Sisters  of  Mercy  and  connected  with  the  College  of  Physicians 
and  Surgeons,  was  organized  and  incorporated  under  the  general 
laws  of  the  State  of  Maryland  in  1899.  Its  first  students  were 
graduated  in  1901 ;  and  on  the  passage  of  the  bill  for  registration 
in  1904  the  Sisters  of  Mercy,  connected  with  the  Hospital  serv- 
ice, received  certificates  as  registered  nurses. 

The  Training  School  was  affiliated  Avith  the  Board  of  Regents 
of  the  State  of  New  York  in  1906;  and  in  the  same  year  the 
Alumnae  Association  was  incorporated,  having  been  previously 
connected  with  the  Associated  Alumnae  of  the  LTnited  States. 
The  graduates,  as  active  members,  have  been  much  interested  in 
the  movements  of  the  Maryland  Association  of  Graduate  Nurses, 
to  whom  they  have  given  every  encouragement  to  uplift  the  pro- 


78  THE  MERCY  HOSPITAL  TRAINING  SCHOOL  FOE  NURSES 

fession  in  its  many  works  of  district  nursing,  tuberculosis  cam- 
paign, Bed  Cross  movements,  etc 

The  requirements  for  entrance  are:  Highest  moral  standing, 
health,  intelligence  and  a  High  School  education  or  its  equivalent. 
The  age  limit  is  twenty  to  thirty-five  years. 

After  a  three  months'  probation,  candidates,  if  they  possess  the 
necessary  qualifications,  are  admitted  to  the  Training  School 
proper,  receiving  five  dollars  a  month  wherewith  to  secure  text- 
books, etc.,  the  education  they  receive  being  considered  their 
compensation.  The  right  is  reserved  to  dismiss  pupils  for  any 
cause  which  may  be  deemed  sufficient  by  the  Sister  Superior  or 
Superintendent. 

The  course  of  training  comprises  three  years  of  theory  and 
practice.  The  clinical  advantages  are  exceptional.  The  medical, 
surgical,  orthopedic,  gynecological,  obstetrical,  children's  and 
dietetic  departments  give  valuable  practical  experience.  The 
nurses  a-re  taught  the  theory  of  nursing  by  class  recitations  and 
demonstrations  by  efficient  Sister  instructors.  Supplementing 
this  training  is  a  course  of  lectures  from  the  professors  of  the 
University  of  Maryland  School  of  Medicine  and  College  of  Phy- 
sicians and  Surgeons,  who  are  untiring  in  their  efforts  to  keep 
the  School  abreast  with  modern  scientific  developments. 

GRADUATES,    1922. 

Name  Address 

Sister  M.  Joan  of  Arc  Wilson Maryland 

Mary   C.    Pottorff .  ,  •  • Pennsylvania 

Anne    Baile    Chenoweth Maryland 

Virginia  Eleanor   Geise •  • Maryland 

Margaret  Howard  Dudley Marvland 

Elizabeth  O'Donnell  Streett Maryland 

Martba  Elizabeth  Flynn Maryland 

Anna  Margaret  Sheridan Maryland 

Catherine  Frances  Prenger Mrayland 

Emma   Garrison   Burdette Maryland 

Mary  Gladys   Scherer •  • Maryland 

Georgia  Seymour  Harness West  Virginia 

Catherine    Spalding    Donavan •  • Maryland 

Rosa  Brunsman    •  •  Maryland 

Laura  Augusta  Greaver •  • ^ ..... .  Virginia 

Helen  Loretta  Miller Maiyland 

Burnetta  Anna  Heininger .  .  -  • Pennsylvania 

Elizabeth  Virginia  Phelps Maryland 

Frances    Boucher   Donavan Maryland 

Mildred  Kathryn  Hoffman West  Virginia 

Julia  Buhrman    •  • Pennsylvania 

Mary  Elizabeth  Dempsey JIaryland 

Elizabeth  Glwendolyn  Ruffli Maryland 

Helen   Louise   Blocker Pcnisylvania 

Mary   Sabina   Breen  .  .  •  • Ohio 

Ruth   Hallie   Matthews West  Virginia 

Eleanor  Margaret  Brubaker •  • Pennsylvania 

Lillian  Ann   Smith .  Pennsylvania 

Helen  Agnes  Lyng Maryland 

Lillian   Ann   Todt Pennsvlvania 


FOEM  OF  DEVISE  OK  BEQUEST 


79 


ENDOWMENT  FUND. 

The  following,   all  Alumni  of  the  University,  constitute  the 
Board  of  Trustees  of  this  Fund : 


Hon.  Henry  Stockbridge,  LL.D. 
Harry  Abler,  M.D. 
Charles  Markell,  LL.B. 
J.  M.  H.  Rowland,  M.D. 


Stuart  S.  Janney,  Esq. 
John  B.  Thomas.  Ph.G. 
B.  Merrill  Hopkinson,  M.D. 
Horace  M.  Davis,  D.C.D. 


Arthur  M.  Shipley,  M.D. 

This  Board  is  incorporated  by  act  of  the  Legislature  of  the 
State,  its  legal  title  being  "The  Trustees  of  the  Endowment  Fund 
of  the  University  of  Maryland,"  and  is  independent  and  self-per- 
petuating, filling  itself  any  vacancies.  Its  powers  are  limited  to 
the  expenditure  of  the  interest  derived  from  the  fund,  which  is 
to  be  applied  in  the  discretion  of  the  Board  for  the  benefit  of  the 
University.  Contributions,  donations  and  bequests  are  solocited 
from  Alumni  and  friends.  They  may  be  made  to  the  general  or 
University  Fund,  to  the  Medical  Fund  or  to  any  other  department 
of  the  University.  If  intended  for  the  School  of  Medicine,  they 
may  be  given  to  the  general  medical  fund  or  to  some  special  ob- 
ject, as  building,  research,  library,  pathology,  hospital,  publica- 
tion, laboratories,  gymnasium,  scholarship,  medal,  prize,  etc.,  in 
which  case  the  wishes  of  the  donor  will  be  strictly  regarded.  At- 
tention is  invited  to  the  "Charles  Frick  Kesearch  Fund,"  already 
established  in  memory  of  that  distinguished  investigator.  Checks 
should  be  made  payable  to  B.  Merrill  Hopkinson,  M.D.,  Treasurer, 
Professional  Building,  Baltimore,  Md. 

FOEMS  OF  DEVISE  OR  BEQUEST. 

To  School  of  Medicine. 

I  give,  devise  and  bequeath  to  the  Regents  of  the  University  of  Maryland, 
a  corporation  incorporated  under  the  laws  of  the  State  of  Maryland,  for  the 

benefit  of  the  Faculty  of  Physic 

(Here  state  amount  or  describe  property.) 


To  Endowment  Fund. 

I  give,  devise  and  bequeath  to  the  Trustees  of  the  Endowment  Fund  of 
the  University  of  Maryland,  a  corporation  incorporated  under  the  laws  of 

the  State  of  Maryland,  for  the  benefit  of  the  Faculty  of  Physic 

(Here  state  amount  or  describe  property.) 


ALUMNI  ASSOCIATION. 

MEDICAL  DEPARTMENT. 

President. 

G.  MlITON    LiXTIIlCCM.   M.D. 

Vice-Presidents. 
Jacob  Bird,  M.D. 
Guy  Steele,  M.D. 
Charles  Bagley,  M.D. 

Recording  Secret orii. 

Wm.  S.  Love,  M.D., 

S36  W.  North  Ave., 

Baltimore,  Mil. 

Assistant  Recording  Secretary. 
Nathan  Winslow,  M.D. 

Corresponding  Secretary. 

Austin  H.  Wood,  M.D., 

817  Park  Aveiiue. 

Baltimore,  Md. 

2'reasurer. 
Herbert  C.  Blake,  M.D. 

Executive  Committee. 
Robert  L.  Mitch  el,  M.D. 
Wm.  J.  Coleman,  M.D.  Frederick  A'lNur,  ^I.D. 

Arthur  G.  Barrett,  M.D.  C.  A.  Clapd.  M.D. 

Alumni  Advisory  Committee. 

B.  Mkrrill  Hopkinson,  M.D. 
E.  B.  Freeman,  M.D.  A.  D.  :McC()Nai  ii  ii;.  .M.D. 

Henry  Fitzhugh,  M.D.  S.  (Jriffitii  Davis.  ;M.D 

Necrologist. 
W.  E.  Magrvdek,  M.D. 


sife^k^.     Ib&Sl    llfcJEp        / 


UNIVERSITY  OF  MARYLAND 

BULLETIN 

OF  THE 

SCHOOL  OF  MEDICINE 


Vol.  VII.  OCTOBER,  1922.  ^o.  2 

SELECTIVE  ANESTHESIA  IN  UROLOaY.* 
Prkltmixary  Report  by  A.  G.  Rytina,  M.  D.,  H.  L.  Tolsox,  M.  D. 

In  the  average  surgical  operation,  the  selection  of  the  anesthetic  is 
a  matter  of  small  moment.  But  in  urological  surgery,  the  type  of 
anesthetic  used  may  be  a  matter  of  the  greatest  importance. 

For  example,  in  the  old  prostatic,  who  may  also  be  the  subject  of 
nephritic,  cardiac,  vascular  or  pulmonary  disease,  the  selection  of 
the  right  kind  of  anesthetic  is  more  important  than  the  method  of 
operative  procedure.  There  are  four  anesthetics  co^mmonly  employed 
by  urologists,  viz.,  nitrous  oxide,  oxygen  anesthesia,  ether  anesthesia, 
local  anesthesia,  and  spinal  anesthesia.  What  we  say  concern- 
ing anesthesia  in  urolog}',  will  be  equally  applicable  to  the  other 
branches  of  surgery  presenting  like  complications  or  conditions. 
The  preference  of  the  one  over  the  other  of  the  first  two  anesthetics, 
viz.,  gas  and  oxygen  and  ether  anesthesia,  is  based  on  the  fact,  that 
gajs  and  oxygen  have  little^  or  no  deleterio'Us  eifect  on  the  kidney  or 
pulmonary  systems,  but  a  depressing  eifect  on  the  cardio-vascular 
systems.  Ether  on  the  othei-  hand  has  a  stimulating  eifec-t  on  the 
cardiac  apparatus,  but  a  deleterious  action  on  both  the:  pulmonary 
and  nephritic  systems.  It  is  easy,  therefore,  in  the  average  case,  to 
decide  which  of  the  two  anesthetics  ought  to  be  the  one  of  choice. 

The  anesthetics,  however,  which  for  us  have  the  greatest  interest, 
and  which  we  regard  as  the  most  important,  are  local  anesthesia 
and  spinal  anesthesia.  It  is  to  these  two  latter  methods,  and  particu- 
larly spinal  anesthesia,  that  we  wish  to  address  ourselves.  In  the  brief 
time  allotted  us,  we  are  only  going  to  consider  these  anesthetics  from 
the  standpoint  of  the  old  prostatic.  After  trying  every  method  of 
operative  procedure  for  removal  of  the  prostate,  we  are  convinced 
in  so  far  as  our  own  experience  is  concerned,  that  the  method  offering 
the  greatest  hope  of  success  is  the  two  stage  suprapubic  prostatectomy. 

*From  the  Morrow  Hospital. 

Read  at  the  Semi-Annual  Meeting  of  the  Medical  and  Chirurg-ieal  Faculty  of 

Maryland.  Held  at  University  of   Maryland,   College   Park. 

Md.,  Nov.  9,  192L 


82 

In  the  last  few  years  we  have  imariably  done  the  first  stage,  viz., 
suprapubic  eystostomy,  under  novocain  anesthesia.  Tlie  operation 
can  be  done  by  this  method  fairly  rapidly,  without  pain  or  shock, 
and  without  disturbance  to  the  pulmonary  or  gastric  systems  that 
often  attend  a  general  anesthetic.  Having  completed  the  first  stage, 
the  second  stage  can  b©  done  at  the  will  of  the  surgeon,  and  for  this 
stage  we  have  of  late  come  to  prefer  spinal  anesthesia.  Indeed,  we 
believe  that  the  technique  which  we  are  attempting  to  perfect  will 
enable  us,  in  a  good  percentage  of  cases,  to  perform  a  one  stage 
prostatectomy,  having  all  the  advantages  of  the  two  stage  prosta- 
tectomy, and  none  of  its  disadvantages. 

In  advocating  spinal  anesthesia  in  urolog}' ,  we  are  fully  aware  that 
some  of  you  have  heard  of  it  almost  before  we  were  bom.  We  kno\\ 
that  it  has  its  limitations  and  we  know  that  it  has  its  dangers.  We 
know  it  is  not  popular,  and  you  will  want  to  know  the  reason.  We 
think  the  reason  is  two-fold.  The  first  is  technical  and  the  second 
psychological.  Any  interne  can  give  ether,  but  it  requires  special 
training  and  care  to  administer  spinal  anesthesia.  The  psychological 
reason  is  the  inate  dread  which  the  surgeon  has  in  puncturing 
the  spinal  canal.  Our  initial  confidence  in  spinal  anesthesia  was 
begotten  by  ten  years,  experience  Avith  the  lumbar  puncture,  and 
treatment  of  neuro'-syphilis  by  intraspinous  injection  of  mercu- 
rialized and  salvarsanized  serum.  In  all  that  time,  we  have  not  seen 
one  case  of  infection,  have  not  had  a  death  or  permanent  paralysis. 

Qur  technique  of  spinal  anesthesia  briefly  is  as  follows:  The 
patient  is  prepared  as  for  an  ordinary  lumbar  puncture.  An  intra- 
spinous needle,  size  18,  is  introduced  in  mid  line  in  the  2nd,  3rd,  or 
■1th  interspinous  space,  the  skin  being  previously  anesthetized  by  a 
solution  of  ethyl  chloride.  2  cc.  of  spinal  fluid  are  withdrawn  and  a 
10  cc.  Luer  syringe  containing  ly^  gr.  of  Apothesine,  dissolved  in 
2  cc.  of  freshly  distilled,  sterilized  water  is  attached  to  the  needle. 
2  cc.  of  spinal  fluid  are  allowed  to  enter  the  syringe  either  by  slight 
suction,  or  by  spinal  fluid  pressure.  The  whole  is  then  gradually 
introduced  into  the  spinal  canal.  The  patient  is  now  turned  on  his 
back,  with  his  head  and  shoulders  slightly  elevated.  Five  minims 
of  adrenalin  and  1/30  gr.  of  strychnine  and  4  gr.  of  cafteine  arc 
now  given  hypodermically.  An  infusion  apparatus,  consisting  of 
salt  solution  and  adrenalin  are  close  at  hand  in  case  the  blood 
pressure  falls  too  low.  Symptoms  of  respiratory  disturbance  may  be 
sufticiently  marked  to  call  for  artificial  respiration,  but  we  have  not 
yet  met  them.  Having  attended  to  all  these  preliminaries,  the  field 
of  o]>eration  is  prepared  in  the  regular  manner,  and  the  operation 
proceeded  with.  The  anesthetic  etfects  begin  almost  immediately, 
and  last  from  one-lialf  to  one  and  one-half  hours  (V2"l^'2  hours), 
depending  on  the  size  of  the  dose  used. 


83 

In  conclusion,  let  us  analyze  the  following  case,  in  order  to  show 
the  merits  of  spinal  anesthesia: 

Dr.  W.,  age  82,  entered  Mercy  Hospital  on  October  5,  1921,  suffer- 
ing with  uremia  and  complete  retention  of  urine.  He  was  referred 
from  Dr.  Chambers'  service  to  the  Urological  Service.  Examination 
showed  the  patient  to  be  markedly  debilitated,  with  some  cardio- 
\ascular  and  pulmonary,  as  well  as  kidney  disturbances.  Rectal 
examination  showed  an  enormously  enlarged  prostate,  and  the  cathe- 
ter withdrew  about  two  quarts  of  residual  urine.  After  careful 
treatment,  the  uremia  disappeared.  Patient,  however,  was  still  very 
weak  and  was  considered  an  extremely  poor  operative  risk.  Eco- 
nomic and  sentimental  reasons  prompted  me  to  attempt  a  supra- 
pubic drainage  under  novocaine  anesthesia  1/2  of  !%•  Following 
this  operation,  patient's  general  condition  markedly  improved.  In 
14  days  the  second  stage  operation  was  performed  under  spinal  anes- 
thesia. To  remove  the  very  large  prostate  weighing  165  grams, 
complete  anesthesia  was  necessary.  The  objections  to  ether  or  gas 
and  oxygen  were  three-fold: 

1.  The  gTeat  danger  of  pneumonia  or  cardiac  complications. 

2.  The  gTcat  danger  of  gastric  disturbance. 

3.  The  great  danger  of  shock  from  hemorrhage. 

It  was  accordingly  decided  to  remove  the  prostate  under  spinal 
anesthesia.  There  was  complete  absence  of  pain,  and  owing  to  the 
low  blood  pressure,  which  is  characteristic,  there  was  practically  no 
bleeding,  in  contrast  to  ether  which  raises  the  blood  pressure,  and 
accentuates  the  hemorrhage.  There  was  also  complete  adbominal 
relaxation,  which  not  only  made  manipulation  easier  but  did  away 
V,  ith  the  danger  of  rupturing  the  peritoneum,  as  occasionally  occurs 
with  light  ether  or  gas  anesthesia.  The  patient  returned  to  his  room 
in  good  condition,  was  stimulated,  and  24  hours  later  was  sitting  up 
in  bed  reading  the  newspaper  and  munching  on  candy.  His  convales- 
cence since  has  been  uneventful,  and  patient  is  now  well. 

Up  to  this  time,  we  have  records  of  nearly  three  hundred  cases  op- 
erated upon  under  spinal  anesthesia.  These  operations  were  nearly 
all  done  at  the  Morrow  Hospital,  a  few  at  the  Mercy  Hospital,  and  one 
at  South  Baltimore  General  Hospital.  The  operations  consisted  of 
the  following  examples :  Circumcisions,  Epididymotomy,  Adenec- 
tomy,  Suprapubic  Drainage,  Suprapubic  Prostatectomy,  ^N^ephrec- 
tomy.  Herniotomy,  External  Urethrotomy,  Appendectomy,  Osteo- 
myelitis of  Leg,  etc.  We  have  not  had  one  death  in  the  series,  and  on 
account  of  the  absence  of  shock,  the  convalescence  is  not  only  better 
but  shortened.  We  have  had  only  one  slight  complication,  viz.,  a 
transient  paralysis  of  the  external  rectus.  A  more  complete  report 
concerning  our  experiences  will  be  forthcoming  in  a  future  com- 
munication. 


84 

AN  ANALYTICAL  STUDY  OF  THE  EXTRACRANIAL 

ANEURISMS  OF  THE  INTERNAL  CAROTID 

ARTERY  RECORDED  BY  AMERICAN 

AUTHORS. 

By  Nathan  Winslow. 

{From   the  Surgical  Department  of  the   University  of  Maryland. ) 

Aneurism  of  the  cervical  portion  of  the  internal  carotid  artery  is 
imconmiou.  From  1808,  when  Cooper^  ligated  the  common  carotid, 
successfully,  for  such  an  aneurism  until  the  present  day  a  most  care- 
ful seach  of  the  literature  reveals  only  101  cases.  These  will  appear 
in  a  series  of  articles  in  the  Bulletin  in  abstract  foi-m  and  analytical 
tables.  The  first  paper  will  be  devoted  to  those  contributed  hy 
American  authors.  They  number  20.  Later  issues  will  contain 
those  of  spontaneous  origin,  39  in  number ;  erosive,  totaling  18 ; 
traumatic,  numbering  25 ;  arterio-venous,  18 ;  and  finally  1  which 
oould  not  be  classified^  as  it  was  found  in  the  dissecting  room.  The 
diagnosis  is  mainly  lietween  abscess,  rarely  malignancy.  Usually  the 
first  intimation  of  its  presence  is  a  bulging  in  the  vicinity  of  the 
tonsil.  For  this  reason  its  prompt  recognition,  when  it  does  occur,- 
is  of  the  utmost  importance,  else  it  may  be  lanced  for  a  tonsillar 
abscess,  with  fatal  result.  A  carefully  taken  history  may  prevent 
this  mistake.  Mudd,^  from  the  history  of  the  swelling  in  the  throat 
antedating  a  scarlatinal  angina,  was  led  to  a  correct  diagnosis. 
Agnew^  stresses  the  ability  of  the  physician  to  hoXh.  see  and  feel 
pulsation.  He  overlooks,  however,  the  possibility  of  the  patient  l>e- 
ing  unable  to  open  the  mouth  snfficiently  for  an  ocular  inspection 
or  to  permit  the  passage  of  a  finger.  Pircher^  saw  a  girl,  aged  S, 
with  a  swelling  under  the  angle  of  the  jaw  which  pre^'ented  the 
patient  from  opening  her  mouth.  He  took  it  for  an  abscess  aud 
attempted,  unsuccessfully,  to  reach  the  pus  by  an  incision  in  the 
neck.  Notwithstanding  the  failure,  the  patient  began  to  improve 
and  was  apparently  on  the  road  to  recovery,  when  without  warning 
there  was  a.  mortal  hemorrhage  from  the  mouth.  Autopsy  re\ealed  a 
ruptured  aneurism  as  the  source  of  the  bleeding.  Fortunately  the 
symptoms  are  not  always  so  abscure.  There  is  a  bulging  of  the 
lateral  pharyngeal  wall  into  the  fauces;  and  the  alimentary  tract  is 
but  a  narrow  slit.  The  swelling  may  be  either  circumscribed  or 
diffuse.  To  touch  it  is  soft  and  elastic  and  pulsates  in  an  expansile 
manner  throughout  its  entire  extent.  Externally  there  mav  Ix"  no 
evidence  of  the  disease;  or  there  may  be  a  fullness;  or  there  may 
l>c  a  distinct  himj)  Ijchind  the  angle  of  the  jaw.  If  a •  stethoscope  be 
]>laced  over  the  swelling  a  bruit  is  heard.  Both  murmur  and  j'tulsa- 
tion  disap])ear  when  the  common  carotid  artery  is  compressed  against 
the  vertebral  column,  to  reappear  immediately  upt)n  the  release  of 
the  compression.  Its  size  is  visibly  decreased  by  the  arrest  of  the 
circulation.      The  patient  may  complain  of  a   roaring  in   the  ear. 


85 

persistent  and  severe  hemicrania,  vertigo  and  weakness.  Swallowing' 
of  solids  is  sometimes  impossible  and  generally  accomplished  with 
difficulty.  Liquids  may  be  regurgitated  through  the  nose.  Dys- 
pnoea is  a  not  uncommon  complaint.  Hoarseness  and  deviation  of 
the  tongue  toward  the  affected  side  have  been  noted.  Diagnostic 
puncture  has  been  employed  but  should  not  be  practised  unless  the 
patient  is  so  situated  that  a  prompt  ligation  of  the  common  or 
internal  carotid  can  be  done  in  the  event  of  rupture  through  the 
path  of  the  needle.  Even  in  the  pTesence  of  aneurism  aspiration 
may  prove  inconclusive  from  the  entanglement  of  the  bore  of  the 
needle  in  clot,  a  dry  draw  resulting.  Both  operating  and  autopsy 
findings  show  that  aneurism  of  the  internal  carotid  does  not  in- 
variably point  in  the  throat.  Moser®  tells  of  a  woman  who  sought 
relief  for  a  swelling  in  the  right  side  of  the  neck  which  pulsated 
synchronously  with  the  heart.  Though  nothing  abnormal  was  seen  in 
the  throat,  at  operation  an  aneurism  was  found  arising  from  the 
internal  carotid.  In  isolated  instances  pulsation  is  absent  or  so 
weak  as  to  escape  detection,  Dubrueil"  diagnosed  a  case  of  this 
sort,  sai'coma,  and  attempting  enucleation  tore  the  sac.  Ligation 
of  the  common  carotid  stopped  the  hemorrhage,  but  the  patient  died 
1-1-  days  later  of  hemiplegia.  Like  mistakes  in  diagnosis  are  only 
to  1)e  avoided  by  the  exercise  of  unusual  care. 

Almost  without  exception  have  those  surgeons  who  have  adopted  a 
waiting  policy  been  rewarded  with  a  mortal  hemorrhage  from  rup- 
ture of  the  sac  into  the  mouth.  'Tis  true  several  instances  of  spon- 
taneous cure^  have  been  reported.  These  are  the  exceptions  not  the 
rule.  Were  this  aneurism  more  accessible  restorative  aneurismorrha- 
phy  wduld  be  the  ideal  treatment.  In  the  arterio-venous  type  it  has 
been  employed  a  few  times  with  satisfaction.  In  the  arterial  type 
it  has  been  tried  out  once.^  This  patient  died  of  a  secondary  hemorr- 
hage. The  operation  of  choice  is  ligation  of  the  internal  carotid 
proximally.^*^  When  this  is  impossible  both  the  common  and  the 
external  carotids  should  be  tied,  as  well  as  any  branches  of  the  latter 
arising  between  the  site  of  ligation  and  the  bifurcation.  By  adopt- 
ing this  plan  the  reestablishment  of  pulsation  in  the  sac  is  prevented. 
Before  permanently  aiTCsting  the  circulation  in  the  internal  carotid 
it  is  recommended  the  common  carotid  be  temporarily  occluded  under 
local  anesthesia.  LTsually  a  defective  cerebral  circulation  vnU 
promptly  manifest  itself.^^"  In  the  face  of  these  warnings  the  ligation 
should  be  removed  without  delay. 

Case.* 
The  patient,  a  negress ;  mai*ried ;  aged,  48 ;  cook ;  was  admitted  to 
the   L'niversitv    Hospital   January   24,    1921,   for   a   rt.    unilateral 
pharvngeal  swelling  of  9  months'  duration.    In  April,  1920,  she  con- 
Reported  in  Annals  of  Surgery,  1922,  LXXV.  694. 


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93 

iuto  the  mouth.  Hulbert  aspirated  the  sac  for  diagnostic  purposes. 
This  procedure  is  questionable,  and  the  surgeon  bold  enough  to  at- 
tempt it,  should  be  prepared  to  do  immediate  ligation  of  either  the 
common  or  internal  carotid.  Spontaneous  rupture  occurred  four 
times.  All  of  these  patients  perished.  Rupture  of  the  sac  after 
operation  occurred  three  times.  Ail  of  these  patients  eventally  died. 
Both  common  carotids  were  tied  by  Agiiew,  but  unsuccessfully. 
The  causes  of  death  were,  disorganization  of  the  brain,  hemorrhage 
following  puncture,  thrombosis  of  the  rt.  lateral  sinus,  spontaneous 
hemorrhage  four  times,  secondary  hemorrhage,  septic  poisoning  and 
no  assignable  cause.  Cerebral  symptoms  after  operation  were  present 
in  one.  In  one,  no  appreciable  bruit  or  pulsation  could  be  elicited. 
Besides  the  cases  tabulated  Deaver  has  reported  an  aneurism  involv- 
ing all  tliree  carotids,  Matas,  a  case,  very  suggestive  of  aneurism 
of  the  internal  carotid  and  Ott  a  case  in  which  both  the  internal 
and  external  carotids  participated  in  the  formation  of  the  aneurism. 

Deaver  (The  Univ.  Med.  Mag.,  1889,  1,  340 )  :  The  trouble  had 
It^gun  20  years  prior  as  a  complication  of  rheumatism;  at  which  time 
it  was  pronounced  an  enlarged  tonsil.  The  tonsil  was'  excised  and 
the  base  repeatedly  cauterized  but  the  lump  continued  to  increase  in 
size.  When  the  patient  consulted  Deaver  the  mass  had  attained  the 
size  of  a  man's  fist  and  presented  bcth  internally  and  externally.  It 
pushed  the  right  pharyngeal  wall  inwards  and  so  diminislied  the 
calibre  of  the  pharynx  as  to  prevent  swallowing  of  solids,  and,  caused 
great  discomfort  in  breathing.  It  pulsated  strongly  both  on  the  in- 
nde  and  on  the  outside  and  in  lioth  localities  an  aneurismal  bruit 
wa.s  distinctly  heard. 

Operation  9-25-1888.  The  common  carotid  was  tied  in  the 
inferior  carotid  triangle.  During  the  induction  of  narcosis  the  man 
ceased  breathing  and  became  cyanosed  and  pulseless.  The  ether 
was  withdrawn  and  artificial  respiration  instituted  without  avail, 
so  iaryngotomy  was  done.  Resuscitation  was  now  only  a  matter  of 
u  few  moments  and  the  operation  was  continued  to  completion.  All 
.'hree  of  the  carotids  were  involved.  The  port -operative  course  was 
uneventful. 

Matas  (Xew  Orleans  Med.  and  Surg.  Jl.,  1884,  XXII,  245): 
Logan  and  Souchon  belie\'ed  this  case  an  aneurism  of  the  internal 
( aroti<l  while  Matas  even  two  years  after  operation  was  inclined  to 
look  upon  it  as  a  fibro-adenoma  of  the  tonsil,  notwithstanding  it 
ha<l  clinically  all  of  the  usual  signs  of  aneurism.  The  pt.,  a  white 
man,  aged  35,  complained  of  dysphagia,  inability  to  eat,  to  speak 
and  to  breathe  properly  on  account  of  a  large  mass  which  nearly 
filled  his  throat.  Six  years  previously  the  man  had  had  an  acute 
iufianmiation  of  the  tliroat  complicated  by  swelling  and  huskiness 
of  the  voice  which  his  medical  attendant  thought  necessary  to  lance 
but  without  apparent  result.     From  that  time  the  swelling  in  the 


04 

rliroat  had  (ontinuoiisly  Imt  iiradually  increased  to  its  present  size. 
Externall,y  was  noticed  an  irregnlar  ovoidal  mass  which  tilled  the 
siil>niaxillary  and  paro'tid  regions.  It  extended  from  the  ear  to  the 
hyoid  bone,  felt  very  hard  and  pidsated  vigorously.  Inside  the 
inonth  was  seen  a  large  bulging  mass  that  projected  into  the  fauces 
from  the  rt.  tonsillar  region.  Intrabuccal  palpation  confirmed  piilsa- 
tion  of  the  whole  mass.  There  was  only  a  narrow  passag'e  left  for 
food  and  drink  and  the  man  was  eom.pelled  to  subsist  on  semi-solid  or 
liquid  diet.  The  uvula  and  the  palate  were  displaced  to  the  left. 
Compression  of  the  common  carotid  caused  arrest  of  all  pulsation 
and  some  diminution  in  the  size  of  the  swelling.  Notwithstandingly. 
Matas  entertained  some  doubts  as  to  its  aneurismal  character,  but 
thought  ligation  was  indicated  and  accordingly  tied  the  common 
carotid  in  the  triangle  of  election.  The  sw^elling  was  immediately 
reduced  in  size.  Two  years  afterw^^rds  the  mass  was  still  present, 
but  was  smaller  and  did  not  pulsate. 

Ott  (Ann.  of  Surg.,  1921,  LXXIV,  517  &  522)  :  A  woman, 
aged  26,  came  to  the  Mayo  Clinic,  for  consultation,  February-  14, 
1913,  Six  years  previously  bleeding  from  the  right  ear  had  com- 
menced. One  year  later  an  operation  was  performed  to  remove  a 
growth.  One  year  afterwards  she  experienced  severe  pain  in  tlie 
head,  throbbing,  dizziness  and  bleeding  from  the  ear  of  more  or  less 
severity.  Examination  revealed  a  pulsating  tumor  in  front  of  tbe 
right  ear  and  another  in  the  left  submaxillary  space.  The  patient 
could  only  open  her  mouth  slightly.  A  diagnosis  was  made  of  an 
aneurism  of  the  right  eixteriial  carotid  ai'tery,  also  aneurism  of  the 
left  internal  carotid  extending  down  to  the  common  carotid.  The 
right  external  carotid  artery  and  internal  jugular  vein  were  ligated 
on  February  20,  1919.  Six  days  later  the  left  common  carotid 
artery  was  tied  just  below  the  bifurcation  for  an  aneurism  whicli 
apparently  involved  both  the  internal  and  external  carotids.  The 
internal  and  external  jugjular  veins  were  also  ligated.  The  patient 
reported  two  years  after  the  operation  the  aneurism  had  shown  no 

signs  of  recurrence. 

REFERENCES. 

1  Cooper— Lectures  of,  3rd  American  Edit.,  1831,  II.  62. 

-Arnould— Bull,  et  mem.  de  la  Soc.  Anat.  de  Par..  1914,  LXXXIX,  168. 

"Mudd  in  Hulbert— St.  Louis  Cour.  Med.,  1886.  XVI.  265. 

■"Agnew^ — Agnew's  Surgery,  1878,  Vol.  1,  p.  591. 

•'-Pircher— Wien.  med.  Wochsft.,  1862.  p.  553 

'Moser — Inaugural  Dissertation,  Strasburg,  1911.  p.   7. 

■Dubrueil— Gaz.  med.  de  Par.,  1883,  LIV,  6.  s.,  373  &  398. 

-'Lyot  &  Petit— Gaz.  med.  de  Par..  1897,  1.  10.  s..  159.  Gasne— Paris  Chi- 
rurgical,  1920,  XII,  212. 

'•McMullen  &  Stanton— Ann.  Surg.,  1910,  LI.  76. 

i"Wyeth— Prize  Essay,  Trans,  of  the  Amer.  Med.  Assoc,  1878,  XXIX. 
appendix,  p.  136. 

"Halsted— Keen's  Surgery.  1911,  Vol.  V,  p.  321. 


95 

TKAUMATIC  RUPTURE  OF  THE  URINARY  BLADDER 

WITH  REPORT  OF  FOUR  CO:NrSECUTIVE  CASES 

WITHOUT  A  FATALITY. 

Edward  S.  Joiixsoiy,  M.  D.,  Baltimore,  Maryland. 

A  survey  of  the  literature  demonstrates  conclusively  that  trau- 
mjatic  rupture  of  the  urinary  bladder  occurs  so  infrequently  that 
seldom  more  than  one  or  two  cases  of  this  condition  are  seen  in  the 
service  of  one  physician  within  a  reasonable  period  of  time.  Conse- 
quently, about  all  the  available  statistics  on  this  subject  are  tabula- 
tions from  the  experiences  of  many  surgeons  which  extends  over 
many  years.  '  For  this  reason  the  records  of  a  single  clinic  (no  matter 
how  large)  are  within  themselves  of  little  value  in  the  way  of  com- 
piled statistics.  It  therefore  behooves  each  of  us  to  record  and  ac- 
curately report  all  of  our  cases  in  the  interest  of  advancement  of  this 
particular  field  of  surgery.  A  failure  to  do  this  has  in  the  past  been 
a  potent  factor  in  keeping  rupture  of  the  bladder  in  the  list  of  uncom- 
mon accidents.  The  comparative  rarity  of  reported  cases  stimulates 
the  writer  to  report  this  series  of  four  consecutive  cases  of  urinary 
bladder  rupture  without  a  fatality,  in  spite  of  hazardous  though  inter- 
esting complications  in  all  but  one  case. 

The  case  histories  are  as  follows: 

Xame: — J.  P.  (^o.  601-14),  age  25  years,  white,  male,  N^ation- 
ality — Pole. 

Admitted  to  St.  Joseph's  Hospital,  October  18th,  1!)14. 

Chief  Complaint : — Pain  in  abdomen  and  back. 

Diagnosis : — Rupture  of  Urinary  Bladder,  and  general  peritonitis. 

Family  and  past  history  not  important. 

Present  Illness  :^Five  days  ago  while  in  a  quarrel  with  a  com- 
lade.  patient  fell  twenty  steps  down  a  flight  of  stairs  and  landed  on 
his  abdomen  against  the  floor.  He  was  temporarily  dazed  and  lay 
motionless  for  a  while,  but  was  later  placed  in  bed  and  made  com- 
fortable. The  following  morning  the  patient  became  decidedly  un- 
comfortable with  nausea,  vomiting  and  pain  in  lower  abdomen,  for 
which  his  physician  ordered  anodynes  and  counterirritants.  The 
patient's  condition  continued  thus  from  Wednesday  until  the  follow- 
ing Sunday  when  he  was  taken  to  the  hospital  at  4 :30  P.  M.  On 
examination  patient  was  found  to  be  in  a  markedly  shocked  state  with 
pulse  weak  and  rapid,  respiration  labored  and  fast,  expression, 
pinched  and  distorted,  lips  covered  by  a  decided  herpes,  tongue  thickly 
coated,  breath  offensive,  mentality  blunted  and  confused.  Bowels 
and  bladder  quiescent  since  accident  five  days  ago.  Vomiting  started 
again  two  days  ago  and  has  continued  to  the  present  time.  Small 
quantities  of  milk  constituted  patient's  diet  since  accident. 

Abdomen  somewhat  distended,  tympanitic  in  median  line  and  dis- 
tinetlv  flat  on  both  sides  and  in  flanks.     Abdominal  wall  risrid  and 


96 

board-like,  tenderness  most  pronounced  over  lower  part  of  abdomen. 
Heart  regular,  all  sounds  clear  and  distinct,  pulse  weak  and  fast. 

Catheterized  specimen,  small  in  amount  and  contained  blood. 
Leukocyte  count  4800,  with  a  90' t  polymoi-pbonuclear.  General 
condition  of  patient  was  poor.  A  diagniosis  of  rupture  of  tbe  bladder 
with  a  general  perionitis  was  made  with  recommendation  for  imme- 
diate operation. 

Operation :- — One  hour  after  admission  patient  was  prepared  for 
operation  and  under  ether  anesthesia  a  low  midline  abdominal  inci- 
sion was  made  and  exploration  revealed  the  abdominal  cavity  filled 
with  bloody  serum  and  urine.  The  intestines  were  red,  inflamed  and 
glued  together  with  a  dense  coating  of  fibrinous  exudate  which  had  a 
tendency  to  bleed  whjen  manipulated.  There  were  no  injuries  noted 
in  the  intestines.  The  urinaiy  bladder  was  next  explored  and  a  rent 
five  and  a  half  to  six  inches  in  length  was  found  running  vertically 
through  the  posterior  wall  and  extending  from  the  prevesical  space 
aliove  and  in  front  to  the  posterior  cul-de-sac  l>ehind.  The  opening 
thus  occupied  the  entire  peritoneal  surface  of  the  bladder.  With  the 
patient  in  the  Trendelenburg  position  the  intestines  were  gently 
packed  off  and  two  traction  sutures  were  inserted,  one  in  each  end  of 
the  bladder  wound  and  the  rent  thus  brought  ivp  free  into  the  ab- 
dominal opening  for  suture.  The  bladder  wall  was  much  thickened, 
friable  and  edematous,  but  with  care  a  continuous  chromic  cat^it 
suture  through  all  the  coats  of  the  bladder  was  inserted  and  a  Lem- 
bert  peritoneal  stitch  of  the  same  material  reinforced  the  primai^' 
suture.  A  large-size  rubber  tube  and  four  cigarette  gauze  drains 
were  carefully  placed  in  the  pelvis  and  the  abdominal  wound  closed 
in  layers.  A  medium  size  soft  rubber  catheter  was  inserted  ]>e?- 
urethra  and  made  fast.  1,000  cc.  of  subcutaneous  salt  were  injected 
during  the  operation  under  both  breasts  and  patient  returned  to  bed 
in  fair  condition. 

The  wound  was  dressed  daily :  Murphy's  proctoclysis  continuous 
method  was  given  for  the  first  eight  days.  Abdominal  drainage  was 
abundant.  The  cathether  was  removed  on  the  fourth  day  and  the 
patient  catheterized  every  eight  hours  until  he  began  to  void  volun- 
tarily, three  days  later.  Drainage  ceased  in  four  weeks  and  the 
wound  was  completely  healed  one  week  later.  During  the  fii*st  week 
the  patient  had  a  stonny  convalescence  due  to  septic  intestinal  paresis 
and  abdominal  gaseous  distention.  But  with  repeated  enemeta  this 
condition  was  finally  overcome.     Result — ciired. 

Name: — H.  O.  (K'o.  275-15)  :  age  38  years,  white,  male. 
Admitted  to  St.  Joseph's  Hospital  May  16th,  1915. 
Cliief  Complaint :— Pain  in  head,  chest,  abdomen  and  hips. 
Diagnosis:- — Rupture  of  urinary  bladder,  fractured  base  of  skull 
and  fractured  seventh  and  eighth  ribs  on  right  side. 


97 

History  of  having  been  rnn  over  by  a  large  touring  car  which  hap- 
pened to  be  in  gear  when  he  started  the  machine  with  a  crank. 
Patient  was  immediately  brought  to  the  hospital  and  on  examination 
he  was  found  to  be  pale  and  shocked,  pulse  weak  and  respiration 
labored  with  an  expiratory  grunt.  'No  paralysis  noted,  but  there  was 
semi-consciousness ;  bleeding  from  right  ear ;  and  pupils  unequal,  but 
otherwise  eyes  were  normal.  Several  abrasions  were  noted  on  head 
and  face.  No  vault  injury  elicited.  Chest  showed  contusions  over 
right  side  with  fracture  of  seventh  and  eighth  ribs  which  were  imme- 
diately immobilized  with  adhesive  plaster. 

Abdomen  was  discolored  over  pubic  area,  extending  doMoi  in  the 
perineum  with  some  tenderness  on  deep  pressure  over  lower  abdomen 
manifested  by  patient's  movements.  There  was  some  little  muscle 
spasm  but  no  dullness  noted  on  percussion.  Extremities  were  nega- 
tive. Catheterized  specimen  showed  macroscopic  blood.  A  hypoder- 
mic of  morphine  and  atrophine  was  given  and  patient  prepared  for 
operation. 

Operation  : — A  low  midline  abdominal  incision  was  made  down  to 
the  peritoneum. which  was  opened  through  a  small  incision  and  abdo- 
men explored.  There  being  no  visible*  evidence  of  trouble,  the  peri- 
toneum was  closed  and  the  superficial  incision  continued  down  over 
the  pubic  region  exposing  a  transverse  fracture  of  the  pubic  arch  with 
two  and  a  half  to  three  inches  separation  of  the  fragments.  A  fur- 
ther examination  revealed  a  two  and  a  half  inch  wound  through  the 
bladder  wall  immediately  under  the  bone  injury,  which  was  slightly 
to  the  right  of  the  median  line.  The  perineum  was  infiltrated  with 
urine  and  blood  clot  which  was  removed  with  warai  salt  gauze.  A 
soft  nibber  urethral  catheter  was  then  passed  freely  into  the  bladder 
thus  demonstrating  no  injury  to  the  urethra. 

The  bladder  wound  was  closed  with  two  rows  of  No.  2  chromic 
catgut  suture  material  and  the  perineum  drained  separately  through 
a  counter  opening  with  a  rubber  tube  and  three  cigarette  gauze 
drains. 

Mv  attention  was  next  called  to  the  fractured  and  widely  separated 
pelvic  arch.  With  some  little  difficulty  the  fragments  were  approxi- 
mated and  a  four  screw  Lane  bone  plate  was  placed  across  the  anter- 
ior and  upper  surfaces  of  the  bone  which  was  quickly  and  easily 
applied,  and  proved  to  be  a  most  efficient  fixing  agent.  A  small  tuck 
of  gauze  was  inserted  and  the  soft  structures  closed. 

For  further  immobilization  only  adhesive  straps  across  the  pelvis 
were  used.  A  catheter  was  made  fast  in  the  urethra  and  the  patient 
returned  to  his  room  in  fair  condition.  Ether  anesthesia  was  used. 
Wound  was  dressed  daily,  catheter  was  removed  on  the  second  day, 
and  patient  voided  voluntarily  six  days  after  the  injury.  All  drains 
^inrere  removed  in  two  weeks  and  the  wound  promptly  healed  Avith 
bone  plate  still  in  place.     Result — cured. 


98 

Name: — J.  J.  (No.  267-16)  ;  age  12,  white,  male. 

Admitted  to  St.  Joseph's  Hospital  March  18th,  1916. 

Chief  Complaint : — Pain  in  abdomen  and  right  leg. 

Diagnosis: — Rnptnre  of  urinary  bladder,  peritonitis  and  a  frac- 
ture of  the  right  femur  at  the  middle  third. 

Past  history  of  no  importance. 

Patient  was  accidentally  run  over  by  a  heavy  truck,  one  of  the  rear 
wheels  passing  over  his  lower  abdomen  and  right  thigh.  On  admis- 
sion to  the  hospital  one-half  hour  after  accident,  patient  was  pale  and 
knocked  out  from  traumatic  shock,  pulse  was  weak,  respiration  nor- 
mal, pupils  equal  and  reacted  to  light  and  accommodation.  No  bleed- 
ing from  the  ears,  mouth  or  nose.  General  attitude  of  the  patient, 
more  or  less  quiet  and  unconcerned  as  to  his  condition  or  surround- 
ings, and  was  aroused  only  by  manipulation  of  the  limb  or  pressure 
on  his  abdomen.     Chest  normal. 

Abdomen  uniformly  tender  on  deep  pressure  noted  by  patient's 
expression  and  movements,  percussion  negative.  Bruises  seen  over 
lower  abdomen,  right  hip,  and  thigh.  Right  leg  is  flaccid,  shortened 
and  externally  rotated  with  foot  lying  flat  on  the  table.  Fracture 
noted  at  the  middle  of  the  femur.  Patient  vomited  while  on  way  to 
the  hospital. 

The  injury  over  the  lower  abdomen  led  me  to  suspect  a  bladder 
complication  and  a  catheterized  specimen  showed  macroscopic  blood. 
Temporary  immobilizing  splints  were  applied  to  the  fracture  and  the 
patient  prepared  for  immediate  operation. 

Operation: — Fnder  ether  anesthesia  the  lower  abdomen  wa? 
opened  in  midline,  contents  explored  and  urinary  bladder  found  to 
liave  a  two  and  a  half  inch  long  intra-peritoneal  rupture.  Traction 
sutures  were  inserted  in  each  end  of  the  tear  and  with  gentle  pull 
by  an  assistant  the  bladder  was  elevated  nicely  into  view  for  suturing. 
A  continuous  No.  2  chromic  catgut  suture  through  all  the  coats  wa? 
used  to  close  the  bladder  wound,  and  a  Lembert  peritoneal  stitch  of 
the  same  material  was  superimposed  as  a  reinforcement.  Abdomen 
drained  with  medium  sized  rubber  tube  and  four  cigarette  drains 
jilaced  in  the  bottom  of  ]>elvis.     Wound  was  closed  in  usual  manner. 

A  soft  rubber  catheter  was  inserted  through  the  urethra  and  mad(^ 
fast  with  adhesive.  The  patient  was  returned  to  bed  in  good  condi- 
tion. 

Post  Operative  Treatment: — Wound  dressed  daily,  continnous 
^.furphy  drip  given  for  the  first  four  days.  Catheter  was  removed 
on  second  day  and  patient  A;oided  naturally  two  days  later.  Drains 
out  and  wound  completely  healed  in  fifteen  days. 

An  X-ray  showed  the  fragments  of  the  fractured  femur  in  bad 
position  after  manipulation  and  attempt  at  correction,  therefore,  the 
0|icii  nif'thod  of  fventuKMit  was  decided  upon. 


99 

Three  weeks  after  the  abdominal  section  the  patient  was  again 
anesthetized  and  by  an  external  incision  the  thigh  was  opened  over 
the  site  of  fracture  and  a  six  screw  bone  plate  applied.  A  large 
araonnt  of  callus  had  been  thrown  out  around  the  fragments  and  this 
was  probably  responsible  for  failure  of  reduction  prior  to  open 
method.  Wound  was  closed  with  a  small  rubber  tissue  drain  which 
was  removed  on  the  third  day.  Patient  made  an  uninterrupted  re- 
covery, no  deformity, 

^ame:- — M,  K.  (ISTo.  118-18),  white,  female;  age  25  years. 

Admitted  to  St.  Joseph's  Hospital,  February  15th,  1918,  complain- 
ing of  severe  abdominal  pain  and  giving  history  of  having  stumbled 
two  days  ago  over  a  plank  in  her  back  yard,  which  threw  her  on 
her  abdomen. 

There  was  considerable  pain  in  lower  abdomen  with  constant  desire 
to  micturate  from  the  onset.  No  urine  had  passed  per  urethra 
since  the  accident  and  any  attempt  to  void  was  accompanied  by  a 
cramp-like  pain  and  burning  in  lower  abdomen, 

Tjower  abdominal  pain,  which  had  gradually  become  worse,  was 
the  outstanding  symptom.  Physical  examination  showed  a  well  de^ 
veloped  young  female,  somewhat  shocked;  pulse,  106;  respiration, 
32;  and  temperature  99.  Blood  pressure,  systolic,  110,  diastolic, 
70.  White  blood  count,  18,000,  with  80%  polymorphonuclear.  Past 
liistory  was  not  important.  No  history  of  cystitis,  habits  temper- 
ate. Abdomen  was  distended  and  tympanitic  anteriorly  and  de- 
cidedly dull  in  both  flanks,  dullness  influenced  by  position.  Entire 
abdomen  was  tender  and  rigid,  and  the  fundus  of  the  bladder  could 
not  be  made  out.  No  evidence  of  external  injury  noted.  Both  kid- 
neys were  palpable  and  not  enlarged.  The  catheterized  specimen  one- 
half  ounce  in  amount,  was  clear  mieroscopically,  but  showed  red  and 
white  blood  cells  under  the  microscope.  Because  of  apparent  anuria 
with  fluid  in  abdominal  cavity  and  presence  of  blood  in  catheterized 
specimen,  a  diagnosis  of  ruptured  bladder  was  made  and  tlie  patient 
immediately  prepared  for  operation. 

Operation : — Fnder  ether  narcosis  the  abdomen  was  opened  by  a 
low  midline  incision,  explored  and  found  to  contain  a  large  amount 
of  straw-colored  uriniferous  fluid.  The  intestines  were  distended 
with  gas,  dull  reddish  in  appearance,  with  many  coils  of  small  intes- 
tines glued  together  by  fibrinous  exudate  into  the  pelvis.  The  pos- 
terior wall  of  the  bladder  showed  a  vertical  tear  two  inches  long 
which  was  sutured  by  two  rows  of  chromic  catgut  suture  materia], 
followed  by  abdominal  drainage  in  the  usual  manner.  No  retention 
catheter  was  used  in  this  case.  The  bladder  was  catheterized  every 
eight  hours  for  five  days,  after  which  time,  patient  began  to  void 
voluntarily.  All  drains  were  out  in  three  weeks,  and  on  the  thirty- 
second  day  patient  returned  home  cured. 


^^^     .-.\>^  \\ 

'' -It  is'mfiicult  to'say  who  performed  the  first  successful  operation 
for  traumatic  rupture  of  the  bladder.  It  has  been  claimed  that  no 
successful  operation  had  been  recorded  until  Sir  William  MacCormac 
^'•teported  his  two  successful  cases  in  1885.  We  find,  howe^'er,  that 
'tels,  seven  years  before,  reported  a  case  of  intraperitoneal  rupture 
operated  upon  by  Walter,  and  was  cured.  In  the  same  series  he  noted 
that  34.2%  of  the  extraperitoneal  cases  which  were  operated  on  had 
lived. 

Probably  the  first  reported  recovery  after  extravasation  of  urine 
in  the  abdominal  cavity  was  the  case  of  Mr.  Chaldecott  in  ISiS,  and 
to  show  the  doubt  that  existed  as  to  the  possibility  of  recovers-  in 
those  days,  one  is  referred  to  the  controversy  between  Dr.  Eben 
Watson  and  Yh.  Gillispie  on  Mr.  Clialdecott's  case. 

There  are  two  important  anatomical  divisions  of  rupture  of  the 
bladder,  namely,  intraperitoneal,  where  the  peritoneal  investment 
is  likewise  involved,  and  the  urine  is  poured  directly  into  the  abdomi- 
nal cavity. 

Second,  extra  or  subperitoneal  with  an  extravasation  of  the  urine 
in  the  tissues  outside  the  peritoneal  cavity.  While  the  ])eritoneum 
scarcely  covers  more  than  half  of  the  bladder  surface,  even  when 
distended,  the  figures  of  I.  E.  Castagnol  indicate  that  the  intraperi- 
toneal rupture  occurs  in  85.5%  of  all  cases,  as  may  be  judged  by 
the  following  table: 

Rivington 90% 

Fenwick 88% 

Bartels 79% 

IJlmann 85% 

Bartels  in  1878  reported  a  series  of  one  hundred  and  sixty-nine 
cases  of  rupture  of  the  bladder  and  found  that  641/2%  were  associated 
with  fracture  of  the  pelvis.  Of  this  number  271/2%  showed  multiple 
fracture,  20.2%  a  diastasis  of  the  symphysis  pubis.  10%  separation 
of  the  scaro-iliac  joint,  24.7%  fracture  of  the  os  pubis.  11%  fracture 
of  the  ischium,  8.2%  fracture  of  the  ilium  and  4.6%  fracture  of  the 
sacrum,  and  os  pubis. 

In  this  series  of  collected  cases,  there  were  ninety-five  operations 
performed  for  intraperitoneal  rupture  with  one  recovery  and  seventy- 
six  operations  were  followed  by  twenty-six  recoveries  in  the  extra- 
peritoneal group  of  cases. 

Sildowitch  in  1903  published  the  records  of  thirty-two  cases  «>f 
intraperitoneal  rupture  of  the  bladder  treated  by  Russian  surgeons 
with  the  result  that  fifteen  were  not  operated,  and  all  died,  and 
seventeen  were  operated  with  only  four  recoveries. 

An  American  surgeon,  D.  Fiske  Jones,  the  same  year  published  far 
more  favorable  statistics.  He  puts  the  mortality,  in  published  cases. 
as  over  60%  before  the  year  of  1892,  and  under  30%  since  that 
time. 


101 

Eeviewing-  the  literature  over  a  period  of  one  liimdred  years  up 
to  1916,  Quain  reported  one  hundred  and  twenty-seven  cases  of  extra- 
}3eritoneal  rupture,  including  one  of  his  own,  with  a  total  mortality 

of  74%. 

By  further  analysis  he  finds  that  in  eighty-three  cases  reported 
]>efore  1890,  there  was  a  mortality  of  86.7%,  and  in  forty-four  cases 
since  that  time,  he  found  that  48%  died.  The  records  since  1905 
show  a  further  improvement  in  so  far  as  the  mortality  has  been 
reduced  to  38%.  Fracture  of  the  pelvis,  in  some  form,  was  invari- 
ably found  to  be  associated  with  the  rent  in  the  bladder,  and  it  is 
possible  that  the  relatively  high  mortality  here  is  due  to  traumatic 
shock  incident  to  serious  crushinu  injuries,  and  not  the  bladder 
wound  which  should  be  classified  as  secondary. 

In  this  type,  a  fracture  is  usually  responsible  for  the  ruptui-e, 
either  directly  or  indirectly,  as  a  spicule  puncturing  the  organ,  a 
crushing  injury  associated  with  collapse  of  the  pelvic  arch,  or  as 
happened  in  case  number  275-15  where  the  bladder  was  pulled  asunder 
because  of  fracture  with  separation  at  site  of  attachment  of  the 
anterior  inferior  surface  of  the  viscus. 

Xow  and  then  the  fracture  will  have  nothing  to  do  with  the 
mechanism  of  the  rupture. 

Dambrin  and  Papin  (1904)  gave  the  mortality  as  43%  in  the 
abdominal  cases,  and  from  1900  to  1907,  Lamotte  recorded  the  most 
favorable  prognosis  up  to  that  time,  with  a  mortality  of  20.5%  for 
the  intraperitoneal  and  9.5%  in  the  extraperitoneal, type.  The  best 
obtainable  statistics  to  date  indicate  that  tabulated  records  vary 
between  20.5%  and  43%  mortality  in  the  intraperitoneal  and  from 
9.5%  to  30%  in  the  extraperitoneal  cases. 

Extraperitoneal  wounds  may  occur  in  most  any  location  in  the 
bladder  and  may  assume  any  size  or  shape,  depending  largely  upon 
the  situation  of  the  bone  injury.  On  the  contrary,  wounds  of  the 
intraperitoneal  variety  will  occur  on  the  posterior  wall  in  more  than 
one-half  the  cases,  the  wound  is  usually  linear,  fairly  clean  cut, 
single  and  vertically  situated.  The  wound  is  less  likely  to  be  mul- 
tiple than  in  the  extraperitoneal  type,  and  when  produced  by  explo- 
sive effect  as  contre-coup,  it  may  be  several  inches  in  length,  indeed, 
case  number  601-14  presented  a  tear  vertical  in  position  which  ex- 
tended across  the  entire  peritoneal  covered  portion  of  the  bladder,  a 
distance  of  five  and  one-half  inches. 

!Many  theories  have  been  advanced  in  an  effort  to  explain  why 
rupture  most  frequently  occurs  on  the  posterior  aspect  of  the  organ. 
Kouet  compares  the  distended  viscus  to  a  solid  organ  resting  upon 
the  superior  pelvic  strait  immediately  over  the  sacral  promontory, 
and  a  blow  over  the  abdominal  w^all,  a  fall  on  the  feet,  or  ischii  will 
initiate  increased  intra-vesical  tension  through  compression  against 
the  sacrum  sufficient  to  produce  a  rupture.     Samuel  Alexander  also 


102 

maintain^  that  rlic  nlo^t  nsnal  cause  of  the  injurv  is  a  crnsli  which 
forces  the  distended  bladder  ag'ainst  the  s^acral  promontory.  Prac- 
tieallv,  these  theories  are  incorrect  ]>ecanse  the  findings  at  operation 
and  occasionally  at  antopsy.  show  that  the  tear  is  seldom  situated  at 
this  liony  protrn&ion.  The  experiments  of  Besley.  Papin.  Damhrin, 
Lamotte  and  others  have  recently  contributed  much  to  refute  these 
theories. 

Verseri  contends  that  the  faseictili  which  compose  the  muscular 
layers  of  the  bladder  offer  the  minimum  thickness  and  support  to- 
the  posterior  wall  and  because  of  this  anatomical  arrangement,  he 
believes  this  to  l^e  the  weakest  area. 

A  blow  of  any  nature  must  of  necessity  be  over  the  anterior  aspect 
of  the  distended  organ,  and  the  physical  laws  of  force  teach  that  the- 
impact  is  transmitted  through  and  around  the  conductive  fluid  to  a 
point  about  opposite  the  origin  of  the  force  in  the  form  of  aceiunu- 
lated  energy.  This  latter  point  invariably  corresjwnds  to  the  area  of 
the  bladder  that  is  least  protected  and  suppoiied  by  its  attachments 
to  the  pelvic  tissues,  the  posterior  wall,  which  represents  the  place 
where  more  than  50%  of  the  ruptures  occur.  Cranial  surgeons  are 
thoroughly  familiar  wiih  fracture  of  the  skull  by  contre-coup.  and 
the  same  type  of  injuiy  very  often  occurs  in  the  bladder. 

It  is  probable  that  all  these,  and  many  more  factors  play  a  part 
in  the  mechanism  of  rupture,  and  the  frequency  of  posterior  wall 
attack  occurs  chiefly  because  this  is  the  weak  spot  for  the  intra- 
peritoneal variety  of  traumatic  rupture. 

!>formal  urine  is  free  from  pathogenic  organisms,  and  for  the  first 
eight  to  twelve  hours,  has  only  slight  irritative  effect  outside  the 
urinary  tract,  but  with  the  onset  of  chemical  changes  in  the  urinary- 
salts,  an  increased  irritation  and  marked  toxic  absoi-ption  usually 
begins.  Tn  the  abdomen  where  there  is  an  absorbing  area  equal  to 
the  entire  skin  surface  there  occurs  an  over\\'helming  toxemia,  unless 
the  process  is  walled  off.  A  virulent  i^eritonitis  may  follow  from 
luijiration  of  intestinal  bacteria  through  the  already  inflamed  intes- 
tinal wall,  or  the  urine  itself  may  Ix"  infected  because  of  ju'e-existing 
cystitis  or  contamination  following  unskillful  and  too 'frequent  cathe- 
terization. In  the  extraperitoneal  tissues  the  irritating  or  infected 
urine  under  ]n*essure  burrows  along  the  fascial  planes,  stripping  it  of 
all  nutrition,  and  thus  converts  this  tissue  into  a  mass  of  devitalized, 
necrotic  fascia.  A  virulent  cellulitis  soon  results  unless  relieved  bv 
early  and  efficient  drainage. 

The  etiology  of  rupture  may  Ije  conveniently  divide<l  into  predis- 
[)Osing  and  exciting  causes.  To  this  may  be  added  certain  so-called 
spontaneous  ruptures  following  pathological  lesions,  ulcers,  atony, 
cystitis  and  prostatic  obstructive  lesions,  such  as  has  l->een  reporte<l 
liv  White  and  Wiorani.  W.  Xohhnann  and  others. 


103 

Intraabdominal  pressure  initiated  by  labor,  micturition  or  strain- 
ing at  stool  have  frequently  been  the  exciting  factor.  An  interesting 
case  has  been  recently  reported  by  C.  B.  Keenan,  which  occurred 
during  labor. 

The  chief  predisposing  causes  are  a  distended  bladder  and  acute 
alcoholism.  Traumatic  rupture  occurs  most  often  in  men  between 
the  ages  of  twenty  and  forty,  and  the  ratio  as  compared  to  women,  is 
nine  to  one.  One-third  of  Bartels  cases  Avere  intoxicated  at  time  of 
injury,  and  one  is  here  presented  with  interesting  correlated  etio- 
logical factors.  Occupational  hazard  and  exposure  to  greater  injury 
occurs  in  the  male  adults  who  frequently  become  intoxicated,  possess 
usually  a  full  bladder,  and  are  less  able  to  protect  themselves  against 
impending  accidents. 

The  exciting  cause  is  direct  or  indirect  violence  which  may  be  so 
slight  under  favorable  predisposing  conditions  as  to  give  rise  to  what 
i>  often  teiTued  a  spontaneous  rupture.  A  careful  history  will  very 
often  elicit  the  cause,  and  it  would  therefore  seem  fitting  to  be  more 
exph^natory  and  call  these  cases  idiopathic  rupture. 

All  authorities  agree  that  the  ouset  of  toxic  or  septic  symptoms 
\ar\-  largely  because  of  the  bacteriological  state  of  the  urine.  Old 
cystitis  cases  early  give  rise  to  alarming  septic  reaction,  as  is  occa- 
sionally seen  in  the  so-called  spontaneous  ruptures  of  pathologic 
origin,  while  a  sterile  urine  may  be  many  days  in  producing  any 
reaction  at  all.  When  one  recalls  that  from  1000  to  2000  cc.  of 
urine  is  l>eing  poured  into  the  abdominal  cavity  every  twenty-four 
hours,  over  an  absorbing  surface  equal  to  the  entire  skin  area  of  the 
body,  why  sbould  there  not  be  evidence  of  absorption  ?  ISTevertheless, 
a  very  small  percentage  of  cases  are  noted  in  the  literature  where 
extravasation  of  blood  and  urine  in  the  abdominal  cavity  is  not 
followed  by  septic  peritonitis.  Eckert  recalls  a  case  reported  by 
Ledderhose  in  which  an  intraperitoneal  rupture  of  the  bladder  was 
found  in  a  patient  seventeen  days  after  injury,  during  operation  for 
evacuation  of  a  small  extraperitoneal  abscess.  JSTo  sigjis  of  perito- 
nitis were  discovered. 

Onlv  the  simple  physiologic  phenomena  of  contractility  and  re- 
tractility of  blood  vessel  walls  can  explain  the  relativel.y  rare  cases 
of  hemorrhage,  because  as  has  been  pointed  out  by  Farabeuf,  the 
liladder  is  copiously  supplied  by  blood,  there  being  a  rich  arterial 
network  in  the  muscular  and  subserous  coats  with  large  venous  plex- 
u^^es  situated  on  the  outer  side. 

Whether  in  the  abdomen  or  paravesical  connective  tissue,  the  blood 
f<;irnis  an  excellent  culture  medium  for  pathogenic  bacteria  which  may 
rapidly  ovei-whelm  the  patient.     (I.  Ei.  Castagnol. ) 

Diagnosis : — Of  the  few  cardinal  points  indicating  the  diagnosis 
of  a  probable  rupture  of  the  bladder,  the  history  of  an  injury  is  most 
important,  and  when  carefully  analyzed  will  prove  to  be  of  invalu- 


104 

able  diagnostic  aid.  A  blow,  fall,  kick  or  any  other  violence  over 
lower  abdomen,  no  matter  how  apparently  insignificant,  may  pi*o- 
duce  a  serions  niptnre  if  the  patient  has  not  voided  Avithin  a  reason- 
able period  of  time.  Indirect  violence  such  as  falling  from  some  dis- 
tance and  landing  on  the  feet  or  ischii,  and  cnishing  injuries  of  the 
pelvis,  are  frequently  associated  with  nrinai*;^'  bladder  rupture. 

The  same  may  he  said  of  intraabdominal  pressure,  as  in  labor, 
defecation,  micturition,  etc.,  and  at  times  a  so-called  spontane- 
ous rupture  occurs  in  a  pathological  bladder.  Here  the  past  his- 
tory of  the  patient  should  always  be  considered,  and  may  aid  ma- 
terially in  arriving  at  a  diagnosis. 

Since  fracture  of  the  pelvis  may  produce  rupture  by  a  spicule  of 
bone  being  driven  into  the  bladder  wall,  by  separation  of  the  pelvic 
arch  with  consequent  tearing  of  the  bladder  or  by  collapse  of  the 
bony  arch  and  crushing  the  organ  against  the  promontory  of  the 
sacrum,  an  X-ray  examination  when  possible,  may  be  a  valuable 
diagnostic  aid,  and  frequently  locate  the  type  and  place  of  nipture. 

Unlike  rupture  of  the  solid  viscera  notably  the  liver,  spleen,  pan- 
creas or  kidney,  there  is  seldom  evidence  of  alarming  hemorrhage, 
but  the  patient  usually  presents  the  picture  of  shock,  of  var\'ing 
severity,  and  complains  of  sudden  pain  in  the  lower  abdomen. 

Frequent,  painful,  unsatisfactory  urination,  inability  to  void,  or 
the  passage  of  only  a  few  drops  of  bloody  urine  under  little  or  no 
pressure,  in  a  previously  healthy  patient  is  the  usual  history,  and 
when  connected  with  an  injuiw,  are  surely  positive,  signs  of  urinary 
tract  damage. 

If  the  kidney  is  the  site,  one  will  usually  obtain  histoiy  of 
trauma  immediately  over  the  kidney,  there  is  tenderness,  enlarge- 
ment of  kidney  area,  or  mass  denoting  a  hematoma  in  flank  with  pas- 
sage of  blood,  but  seldom  any  clots.  The  ureters  are  rarely  severed 
except  in  mutilating  crushing  injuries  of  the  pelvis,  and  a  diagnosis 
of  rupture  of  the  urethra  is  easily  made  by  tumefaction  along  the 
urethra,  discoloration  in  perineum  and  scrotum,  and  spontaneous 
flow  of  blood  from  the  urethra.  Such  a  case  will  ustially  offer  obstruc- 
tion to  catheterization.  Tn  contusion  of  the  kidney,  the  initial  shock 
is  not  so  pronounced  and  rather  than  become  worse,  it  tends  to  o;et 
better  and  finally  pass  off,  leaving  a  slight  hematuria  for  a  few  day? 
as  the  only  symptom. 

Rupture  of  the  stomach  is  accompanied  by  epigastric  pain,  muscle 
spasm  and  tenderness,  while  the  pelvis  is  negative.  Explosive  vomit- 
ing of  blood  at  times  in  largo  quantities  may  be  noted.  The  shock 
is  pronounced. 

Intestinal  rnpture  is  often  difiicult  to  differentiate  and  is  manv 
times  missed  until  symptoms  of  peritonitis  begin.  The  passage  of 
blood  per  rectum  and  a  neerative  gen i to-urinary  tract  would  point 
toward  the  intestinal  injury. 


105 

Xausea  and  vomiting  may  be  an  initial  symptom,  but  usually 
comes  on  later  with  the  symptom  complex  of  peritonitis,  or  with  the 
beginning  of  sepsis  and  cellulitis  in  the  extra  or  subperitoneal  extra- 
vasation. 

The  absence  of  a  wound  or  injury  over  the  kidney  or  urethra 
where  blood  is  present  in  a  small  amount  or  urine  obtained  by  cathe- 
terization at  a  time  when  the  bladder  should  be  full,  should  in  the 
presence  of  positive  history  and  other  presumptive  signs  justify  ex- 
ploration.. 

On'  the  other  hand,  a  large  amount  of  urine  will  not  exclude  the 
possibility  of  a  rupture  since  one  may  be  either  draining  the  perito- 
neal cavity,  or  evacuating  an  extraperitoneal  sac  of  urine.  Indeed 
if  more  than  735  cc.  in  the  male  and  680  cc.  in  the  female  l>e 
obtained  according  to  Rauber,  one  should  consider  this  more  signifi- 
cant than  no  urine  at  all. 

Free  fluid  may  be  noted  in  either  flank,  or  a  distinct  tumor  mass 
(after  catheterization),  in  the  prevesical  space.  Edema,  discolora- 
tion and  tenderness  in  the  prevesical  space,  inguinal  regions,  flanks, 
perineum  or  scrotum  are  diagnostic  aids  in  the  subperitoneal  type  of 
eases. 

Examination  of  the  abdomen  shows  superficial  chest  breathing, 
with  immobilization  of  lower  abdomen  and  muscle  spasm,  but  no 
rigidity  in  the  early  stages.  Deep  inspiration  excites  acute  cutting 
or  burning  pain  in  bladder,  often  accompanied  by  an  increased  de- 
sire to  micturate,  and  a  sensation  similar  to  pouring  hot  fluid  in  the 
belly  has  been  experienced. 

Shock  is  most  often  the  outstanding  subjective  symptom,  and  may 
v^rv  from  slight  syncope  to  collapse,  depending  upon  the  nature  of 
the  injury  and  the  associated  complications.  The  picture  is  seldom 
that  of  hemorrhage,  and  should  be  easily  differentiated  in  the  cases 
not  complicated  by  this  rather  rare  occurrence.  The  pulse  is  rapid, 
ranging  between  one  hundred  and  thirty  and  one  hundred  and  forty 
with  fair  volume,  and  temperature  may  be  but  little  influenced.  If 
not  in  a  state  of  collapse  the  patient  is  complaining  of  pelvic  discom- 
fort, the  principal  part  of  which  is  referable  to  the  bladder.  Abdom- 
inal contusion  may  be-  confusing,  but  here  again  the  shock  tender- 
ness and  muscle  spasm  veiw  early  disappear  while  the  reverse  is  true 
in  rupture  of  the  bladder. 

In  the  hands  of  a  skilled  operator  the  cystoscope  may  be  of  some 
diagnostic  aid  in  localizing  the  wound  and  its  situation,  particularly 
if  it  be  small.  But  one  is  in  many  cases  handicapped  by  a  cloudy 
fluid  or  a  collapsed  bladder  which  renders  the  cystoscope  pracrically 
useless. 

Technique  of  the  injection  of  sterile  gas  or  fluid  into  the  bladder 
has  been  dwelt  upon  by  Alexander,  Bro"v\ai,  Keen  and  others,  but  be- 
cause of  The  added  s^hock.  possibility  of  contamination,  or  spreading 


106 

the  existiiiG,'  infection,  many  present  day  surgeons  consider  snch  a 
procedure  ordinarily  unwise  and  unnecessary. 

Treatment : — All  cases  should  be  operated  upon  as  soon  as  possible 
and  the  operator  aims  first  to  close  the  rent  and  then  institute  appro- 
priate drainage. 

Recent  rupture  of  a  clean  bladder  will  require  but  little  drainage, 
wliile  late  eases  and  those  presenting-  cystitis  will  be  ]>est  treated  by 
generous  drainage.  Traumatic  shock  is  frequently  a  factor  to  deal 
with  and  not  infrequently  will  delay  surgical  interference,  while  a 
low  percentage  of  small  holes,  especially  if  inaccessibly  situated  will 
close  spontaneously,  provided  adequate  drainage  is  inaugurated.  This 
the  A\Titer  has  ex|>erienced  in  two  recent  cases  of  gunshot  wounds  of 
the  base  of  the  bladder. 

'  The  Trendelenburg"  position  (moderate)  and  a  fair  sized  incision 
Avith  a  good  light  make  for  exposure  and  easy  closure  of  the  wound. 

Spontaneous  recoveries  are  reported,  but  less  than  1%  of  intra- 
]ieritoneal  rupture  will  get  well  without  operation,  and  this  allows  too 
small  a  margin  to  be  worthy  of  serious  consideration.  In  1S68  Thorp 
reported  a  case  where  the  peritoneal  sac  was  washed  out  with  tepid 
water  through  the  bladder  injury,  followed  by  recovery,  and  nine 
years  later  a  case  was  reported  by  Morris,  while  more  recently  Sieur 
:iiid  Bubrijadoux  have  added  another  spontaneous  recovery. 

Cause  of  Death : — Those  cases  complicated  by  fracture  of  the  pel- 
A'is  die  from  shock  soon  after  the  injury,  or  following  operation,  and 
the  mortality  in  uncomplicated  cases  is  usually  produced  by  peritoni- 
tis, cellulitis,  abscess  or  sepsis.  Fatal  primary  hemorrhage  is  rare, 
while  secondary  bleeding  in  the  extraperitoneal  type  is  more  frequent- 
ly seen.  Tn  order  of  frequency  shock,  infection  in  its  many  mani- 
festations, and  hemorrhage  rank  as  outstanding  factors  producing 
death. 

Co:^CT.usio>rs. 

While  traumatic  rupture  of  the  urinary  bladder  may  be  looked 
upon  as  one  of  the  uncommon  accidents,  it  is  nevertheless  more  fre- 
quently met  with  than  the  literature  would  seem  to  indicate,  liecause 
many  of  the  cases  are  not  reported. 

luijtrovement  in  teclniique  and  earlier  surgical  aid  has  reduced 
the  mortality  from  60%  to  less  than  30'^  in  the  last  thirty  years. 

Shock  attending  fracture  of  the  pelvis,  and  otlier  crushing  injuries 
arc  undoubtedly  responsible  in  a  large  dogroc  for  tlie  present  day 
high  mortality  in  these  cases. 

More  than  88'^r  of  bladder  rupture  occurs  in  men. 

Only  one  of  this  series  of  cases  was  associated  Avith  fracture  of  the 
pelvis,  yet,  statistics  show  that  two-thirds  of  all  cases  are  complicated 
liv  this  injuiw. 


107 

Of  the  intrai3€ritQiieal  ruptures,  explosive  effect  bv  c-ontre-coup 
luust  be  considered  an  important  etiological  factor  in  many  cases. 

Suturing  the  rent  with  abdominal  or  previvesical  drainage  is  the 
treatment  of  choice,  yet  small  wounds  of  the  bladder  will  readily  heal, 
provided  proper  drainage  is  carried  out. 

Spontaneous  recoveries  are  reported  in  from  one-half  to  one  per 
cent,  of  cases. 

Intraperitoneal  rupture  occurs  five  times  as  often  as  the  extra- 
pen  toneal  type. 

i^otwithstanding  the  fact  that  the  bladder  is  richly  supplied  by 
blood  vessels,  it  is  rare  to  find  hemorrhage  in  an  alarming  degree. 

The  literature  clearly  shows  that  many  of  these  cases  come  to  the 
hospital  late,  because  of  a  failure  in  diagnosis,  or  late  medical  advice 
sought  by  the  patient. 

A  history  indicating  a  pre-existing  distended  bladder  is  obtainable 
in  most  cases. 

In  case  of  doubt  alwut  bladder  rupture,  ^t  oftimes  proves  better  to 
explore  than  to  wait  for  evidences  of  urinary  extravasation,  or  peri- 
tonitis. 

REFERENCES. 

^Alexander — Ann.  of  Surgery,  August,  1903. 

-Bartels— Arch.  f.  klin.  Chir.,  Berlin,  1878,  XXII,  519. 

■'Besley — Paper  before  Chicago  Surg.  Society,  February,  1907. 

-•Castagnol— Int.  Clinics,  4  :  230—1918. 

^Chaldecott— Prov.  Med.  &  Surgery  Journal,  1846,  p.  333. 

'Dambrin  &  Papin — Ann.  d.  mal.  d.  org.  genito  urin..  Par.,  1904,  XXII,  641. 

"Eckert— Rhode  I.  Med.  Jl.;  116,  May,  1917. 

*Fenwick — Brit.  Med.  J.,  May  19th,  1896. 

^Gillispie— Edinburgh  Month.  J.,  1848. 

lOHorwitz — Ann.  of  Surgery,  1905. 

iiJones — Ann.  of  Surgery,  February,  1903. 

i-Keenan — Canadian  Med.  Ass.  Jl.,  459,  June,  1921. 

i^Kohlmann,  New  Orleans  M.  and  S.  JL,   August,  1919. 

"Morris— Royal  Med.  &  Surg.  Soc,  Feb.  22nd,  1887. 

isQuick — Ann.  of  Surgery,  January,  1907. 

ifiQuain— Surg.  Gyn.  &  Obs.,  July,  1917. 

I'Rivington- "Rupt.  Bladder,"  Diet,  of  Surg..  Vol.  1,  p.  152. 

i^Sildowitch— Cit.  Treves  Op.  Surg.,  Vol.  1,  Chapter  XXXI,  p.  595. 

i^Thorp— Dublin  Quart.  Jl.,  1868.  p.  306. 

-('Ulmann— Wiener  Med.  Woch.,  1888. 

-iWatson— Edinburgh  Month.  Jl.,  1848. 

"White  &  Wingram— Brit.  Jl.  Surgery,    Oct.,  1916. 

-'Walsham— Brit.  Med.  Jl.,  Jan.  28,  1888. 


108 

EDITOEIAL. 

Burt  J.  Asper. 

Efforts  are  l>eing  made  to  provide  a  suitable  memorial  to  the 
memory  of  Burt  J.  Asper,  medallist,  class  of  1911,  lost  with  the 
Cyclops.  If  the  sum  realized  is  sufficient,  a  scholarship  will  be 
esftablished,  otherwise  ihe  interest  from  the  money  collected  will  be 
devoted  to  the  purchase  of  new  books  and  journals  for  the  library. 
In  the  latter  event  an  appropriate  book-plate  will  be  made  and  a 
copy  placed  in  those  books  purchased  from  the  fund.  These  have 
<:'ontributed : 

Dr.  Adolph  Mulstein.  class  of  1911,  4  Willett  St.,  N.  Y.,  N.  Y..  .$15.00 

Dr.  C.  A.  Waters,  class  of  1911.  1100  N.  Charles  St..  Balto 10.00 

Anonymous 10.00 

Dr.  Paul  P.  McCain,  class  of  1911,  Sanatorium,  N.  C 10.00 

Dr.  E.  J.  Nichols,  class  of  1911,  Pikesville,  Md 5.00 

Dr.  Vernon  Oler,  class  of  1911,  Billings,  Montana 5.00 

Dr.  Charles  R.  Law,  class  of  1911,  Berlin,  Md 5.00 

This  is  a  belated  eifort  to  do  justice  to  the  memory  of  a  fellow 
alumnus  who  was  an  honor  and  a  credit  to  the  ITniversity  of  Mary- 
land. He  gave  his  all,  a  life  full  of  prospects  of  infinite  success. 
Let's  make  the  memorial  worthy  of  the  man.  Remittances  may  be 
made  to  ^STathan  Winslow,  University  Hospital,  Baltimore.  What- 
ever amoimit  you  give  will  be  turned  over  to  the  Endovnnent  Com- 
mittee, thus  insuring  its  proi>er  administration.  The  following 
letter  is  self-explanatory : 

June  29,  1922. 

Dear  Dr.  Winslow: 

Your  letter  of  June  26,  containing  checks  and  cash 
amounting  to  sixty  dollars  has  been  received.  I  have 
opened  an  account  in  the  Central  Savings  Bank,  with  the 
above,  in  the  name  of  Dr.  Burt  J.  Asper,  Memorial  Fund, 
of  the  University  of  INId.  Eudowment  Fund. 

Very  sincerely, 

B.  Merrill  Hopkinson,. 

Treasurer. 


109 


Join  Up  j^ow. 

It  is  the  desire  to  make  the  Medical  Ahimiii  Association  a  distinc- 
ti\'e,  a  strong  factor  in  the  influence  for  growth,  efficiency  and  sincere 
help,  in  the  affairs  of  the  Department  of  Medicine  in  the  University 
of  Maiyland. 

With  a  strong  dominant  Medical  Alumni  Association,  the  greatest 
amonnt  of  aid  can  be  rendered  to  the  whole  University  so  that  its 
great  importance  to  the  entire  country  can  be  demonstrated. 

The  graduates  of  each  department  of  the  University,  building  a 
paramount  association,  their  combined  activities,  united  by  a  general 
executive  committee  can  create  an  authority  for  good,  of  a  tremen- 
dous value. 

The  history  and  achievements  of  the  University  and  its  combined 
schools,  The  Baltimore  Medical  and  College  of  Physicians  is  one  of 
which  every  graduate  should  be  proud ;  and  he  should  feel  that  it  is 
an  honor  and  duty  to  help  in  every  way  for  a  bigger  and  lietter 
University. 

This  is  the  time  to  join  in  the  forward  movements  of  this  Univer- 
sity, its  past  lives  for  itself  worthily  respected,  but  its  future  is  in  the 
hands  of  the  Alumni. 

There  is  evidently  some  reason  why  this  school  of  medicine  has  not 
drawn  to  it  large  endowments,  from  individuals  or  educational  funds. 

The  governing  body,  is  struggling  to  make  it  worthy  of  greater 
confidence  in  every  way. 

Its  roster  is  full  to  overflowing,  its  graduates  are  successful  yet 
there  is  a  "something"  w^hich  needs  attention,  the  University  wants 
your  moral  help  and  moral  support. 

Let  every  graduate  therefore  feel  a  personal  interest,  let  its  six 
thousand  speak  for  the  good,  let  your  voice  be  for  progress. 

If  you  feel  that  it  is  not  conducted  as  it  should  be.  make  helpful 
suggestions. 

Join  this  association  and  thereby  create  a  body  wliose  sole  interest 
is  the  University. 

Send  one  dollar  to  Dr.  Herbert  Blake.  Treasurer,  for  membership 
and  be  a  factor  in  this  great  work. 

A  letter  from  tlie  President  of  the  Alumni  Association. 

Dear  Fellow  Alumnus : 

While  we  may  not  personally  be  known  each  to  the  other,  yet  there 
is  the  relationship  of  the  same  educational  mother  that  we  enjoy ;  so 
that  w^e  are  tied  together  by  the  ties  of  inheritance.  The  same  mother 
gave  to  us  the  ways  and  means  of  earning  a  livelihood,  gave  to  us  the 
right  to  stand  out  in  our  community  as  trained  physicians. 


110 

It  is  of  interest  to  recall  the  origin  and  age  of  our  University.  In 
1 799  there  was  started,  under  an  act  of  the  Legislature,  a  state  medi- 
cal society  known  as  the  Medical  and  Chirurgical  Faculty  of  Mary- 
land. Some  of  its  members,  especially  might  he  mentioned  Drs. 
CraAA^'ord.  DaAidge,  Cocke.  Shaw,  soon  saw  the  need  of  a  medical 
school,  resulting  in  Dr.  John  Shaw,  then  of  Annapolis,  drawing  a  bill 
creating  the  College  of  Medicine  of  Maryland,  which  by  enactment 
of  the  Legislature  became  effective  December  18,  1807. 

This  bill  made  the  President  of  the  Medical  and  Chirurgical  Fac- 
ulty the  Chancellor  of  the  College,  and  reports  were  to  be  made  bian- 
nually  to  the  Faculty.  In  1812  the  first  building  to  house  the  school 
was  begun,  modeled  after  the  Pantheon  at  Rome,  and  still  stands  in 
its  splendid  proportions,  doing  duty  as  the  Administration  Building. 

In  1832  Washington  College  was  incorporated,  reorganized  in 
1867,  and  ten  years  later  amalgamated  with  the  College  of  Physi- 
cians and  Surgeons,  which  in  191.5  merged  with  the  T'niversity  of 
^laryland. 

In  1881  was  founded  the  Baltimore  Medical  College,  succeeding 
with  amazing  rapidity,  and  merged  with  the  L'niversity  of  Maryland 
in  1913,  as  a  course  of  progress  and  strength. 

Following  the  union  of  these  three  schools  into  one  compact  whole, 
which  was  in  line  with  higher  medical  education,  made  for  a  strong 
university.  It  was  then  felt,  a  university  imder  the  aegis  of  the 
State  of  Maryland  combining  various  departments  of  a  university, 
such  as  arts,  law,  medicine,  dentistry,  phai-macy,  etc.,  under  state 
supervision,  was  desirable. 

The  General  Assembly  of  Maryland,  by  adoption  of  a  new  charter 
created  the  (new)  LTniversity  of  Maryland  in  1920.  By  this  act  each 
alumnus  of  the  three  schools  became  an  alumnus  of  the  University  of 
Maryland  as  now  constituted. 

Today  there  are  approximately  6,000  medical  alumni  of  this  new 
I'niversity,  each  entitled  to  all  the  rights  and  privileges  of  its  mem- 
bership, not  one  enjoys  any  prestige  more  than  the  others. 

Enjoying  the  same  rights  carries  witli  it  the  essential  obligations, 
duties,  and  loyalty  to  it. 

In  this  transition  there  are  certain  to  result  possible  rough  points 
in  management  and  teaching,  all  of  which  are  gradually  being  elim- 
inated. In  the  course  of  a  few  years,  with  tlie  State  of  Maryland  its 
s])onsor,  coordinating  and  adjusting  its  whole  public  school  system, 
there  is  evolving  a  system  in  this  progressive  state,  with  this  Univer- 
sity as  the  flimax,  equal  to  those  of  the  great  West. 

The  Alumni  Association  of  tlie  Medical  Department,  sent  letters 
to  all  of  the  graduates;  many  have  already  responded,  but  not  all. 

To  make  your  University  the  success  that  it  deserves,  we  must  have 
every  one  join  and  bocmue  interested  in  its  upbnilding.     The  voice  of 


Ill 

the  alumni  must  be  unanimous,  its  tones  should  l)e  so  loud,  rliat  ir 
can  be  heard  throughout  the  land. 

The  graduates  now  leaving  the  school  are  thoroughly  prepared, 
practically  all  pass  the  State  Boards ;  and  are  occupying  positions  of 
trust  and  honor.  Their  writings  and  research  work  are  daily  seen, 
but  they  are  a  modest  bunch,  and  do  not  always  give  credit  to  their 
school. 

I  wish,  it  were  so  I  could  talk  directl_y  to  you,  but  the  old  alumni 
association  is  a  thing  of  the  past.  Help  the  men  who  are  striving  to 
make  this  one  a  success,  and  let  me  hear  directly  from  you.  Write 
and  send  in  your  application  to  Blake :  let  us  make  for  a  5,000  mem 
1')ership.     A  thousand  have  sent  in  their  subscriptions.     Have  you  ( 

G.  MiLTox  LixTHicu:\i,  M.  D. 

ITEMS. 

Dr.  W.  Houston  Toulson  lias  located  at  214  W.  Monument  Street, 
Baltimore.  He  will  limit  his  practice  to  the  diseases  of  the  genito- 
urinary tract.  . 

Dr.  Andrew  C.  Gillis  has  announced  the  removal  of  his  office  to 
1088  Xorth  Charles  St.,  Baltimore.  He  limits  his  practice  to  nervous 
and  mental  diseases. 

Dr.  J.  Standing  N^orman,  class  of  1909.  writes  that  he  has  removed 
to  Kings  Mountain,  X.  (\  He  will  limit  his  practice  to  pediatries 
and  ]-oentgenology.  He  was  formerly  located  at  Lumberton,  N.  C, 
where  he  was  pediatrician  and  roentgenologist  to  the  Lumlx-rton 
Hospital.  Kings  ^fountain  is  in  the  lieautiful  Piedmont  section 
and  a  delightful  place  to  live  in.  Dr.  l^orman  intends  to  do  some 
post-graduate  work  either  in  Baltimore  or  ISTew  York,  this  fall. 
Make  it  Baltimore,  wc  are  glad  to  have  you  with  us. 

Dr.  Eustathius  Chancellor,  class  of  1877,  assistant  resident  physi- 
cian University  Hospital,  1877-1878,  and  assistant  to  Dr.  Francis  T. 
Miles,  1878-1879,  who  has  been  in  active  practice  in  St.  Louis,  Mo., 
for  more  than  40  years,  is  rapidly  recovering  from  a  "stroke."  He 
will  remove  to  the  vicinity  of  San  Diego,  Cal.,  in  the  fall. 

Dr.  R.  W.  Johnson  luis  resigned  as  superintendent  of  the  South 
Baltimore  General  Hospital.  He  Avill  be  succeeded  by  Dr.  W.  B. 
Dalton.  formerly  a  resident  physician  at  the  Maryland  General 
Hospital. 

The  Baltimore^  Clnipter  of  the  Daughters  of  the  American  Revolu- 
tion have  preseutod  to  the  ITniversity  Hospital  $1,000.00,  to  be  de- 
voted to  the  maintenance  of  a  bed  in  the  maternity. 

Dr.  H.  C.  Irwin  has  located  in  Pocatello,  Idaho.  He  has  his  offices 
in  the  Carlson  Building  and  limits  his  practice  to  surgery. 

Dr.  Theodore  W.  Schaefer,  class  of  1880,  of  Kansas  City,  Mo., 
has  an  article  in  Aniei'ican  ^Fcdicine.  1921,  n.  s.,  XYI,  60.5.  entitled 


112 

"The  Application  of  the  Binet-Simon  Tests  for  Intelligence  to 
Patients  by  the  General  Practitioner." 

The  friends  of  Dr.  Kivv  Pearlstine,  of  Charleston,  S.  C,  will  l>e 
glad  to  hear  that  he  has  resumed  his  practice  after  a  period  of  in- 
activity of  three  months  spent  in  a  hospital  with  a  broken  back,  dne 
to  an  explosion  on  a  gasoline  launch.     The  accident  occurred  in  July, 

1921,  while  Dr.  Pearlstine  was  on  his  way  to  see  a  patient  on  a 
British  vessel  lying  in  Charleston  harlwr. 

Dr.  John  R.  Abercrombie  has  removed  his  offices  and  residence  to 
n524  York  Road,  Guilford,  Baltimore. 

Doctor  Charles  Halliday,  P.  &  S.,  class  of  1004,  of  the  United 
States  Public  Health  Service  has  been  awarded  the  decoration 
"Krzys  Walecznych,"  by  Poland  for  services  rendered  that  country 
while  attached  to  the  American  Red  Cross  in  1919  and  1920.  The 
presentation  was  made  by  Major  K.  Mack,  military  attache  of  the 
Polish  legation  to  the  United  States.  This  is  the  second  decoration 
received  by  Dr.  Halliday  from  the  Government  of  Poland,  the  first 
having  been  awarded  for  services  rendered  by  him  to  the  Polish 
Army  in  France  during  the  late  war. 

Dr.  William  Hollister  requests  us  to  announce  the  formation  of  a 
student  volunteer  band  at  the  Medical  School. 

Dr.  George  A.  Straus  has  removed  his  office  to  the  Walbert,  1 SOO 
^'.  Charles  St.,  Baltimore^,  Md.    His  practice  is  limited  to  gynecolog;^'. 

Dr.  iST.  H.  D.  Cox  has  announced  the  removal  of  his  city  office  to 
714  Park  Avenue. 

Drs.  J.  W.  Pierson  and  C.  A.  Waters,  723  St.  Paul  Street,  Balti- 
more, have  installed  at  the  above  address  the  new  type  high  voltage 
X-ray  treatment  machine  for  deep  X-ray  therapy. 

Dr.  Frank  Marino  has  opened  offices  at  1300  St.  Paul  Street,  Bal- 
timore.    His  practice  is  limited  to  general  surgery  and  consultation. 

Dr.  Charles  S.  Leyv  has  opened  offices  at  913  N".  Charles  Street, 
Baltimore.  His  practice  is  limited  to  urologv  and  urological  sur- 
gery in  men  and  women. 

Dr.  Gilbert  T.  Smith,  class  of  1897,  for  the  past  twenty  years 
connected  with  prominent  State  hospitals :  formerly  assistant  super- 
intendent of  the  South  Dakota  Hospital  for  Insane,  Yankton,  S.  D. : 
recently  assistant  superintendent  ^Fansfield  State  Training  School 
and  Hospital,  Mansfield  Depot,  Connecticut,  was  appointed  in  April, 

1922,  Chief  Surgeon  S/S/  "]k[ount  Carroll,"  United  American  Lines, 
Inc.,  39  Broadway,  ]^ew  York,  X.  Y.  When  last  heard  from  he  was 
in   Hamburg,    Germany. 

A  son,  William  Lee  Hart,  Junior,  was  born  to  Major  William  Lee 
Hart.  Medical  Corps,  U.  S.  Anuy,  class  of  1906,  and  Mrs.  Hart,  at 
Fort  Sam  Houston,  San  Antonio."  Tex.,  April  4.  1922. 


.  113 

DExlTHS. 

Dr.  James  Merritt  Corkran,  class  of  1887,  of  Centreville,  Md., 
died  August  11,  1922,  at  the  University  Hospital,  Baltimore,  Md., 
iifter  an  operation  for  carcinoma  of  the  rectum,  aged  62. 

Dr.  Archibald  A.  Campbell,  of  Statesville,  iS[.  C,  class  of  1889, 
died  suddenly  from  heart  disease,  July  IT,  1922,  aged  Q6. 

Dr.  William  P.  Horton,  Xorthwilkesboro,  X.  C,  B.  M.  C,  class 
of  1892,  died  May  6,  1922,  aged  55. 

Dr.  Zachary  Duvall  Ridout,  St.  Margarets,  Maryland,  class  of 
1869,  died  May  8,  1922. 

Dr.  xibraham  Given  Shortle,  Albuquerque,  N.  M.,  B.  M.  C,  class 
of  1896,  died  May  26,  1922,  aged  41,  from  septicemia. 

Dr.  Thomas  A.  Matthews,  class  of  1890,  of  Castalia,  N".  C,  died 
April  29,  1922,  aged  54,  following  a  long  illness. 

Dr.  Theron  Eari  Roe,  Tigerville,  S.  C,  P.  &  S.,  class  of  1910, 
died  May  11,  1922,  aged  34,  from  cerebral  hemorrhage. 

Dr.  Joseph  B.  Waples,  Georgetown,  Del.,  class  of  1868,  died  May 
19,  1922,  aged  75,  from  cerebral  hemorrhage. 

Dr.  John  Woodson  Caines,  Cuyahoga  Falls,  Ohio,  B.  M.  C,  class 
of  1905,  a  lieutenant  in  the  Medical  Corps,  during  the  World  War, 
died  June  5,  1922,  aged  42. 

Dr.  ISTelson  Stiles,  Medford,  Okla.,  P.  &  S.,  class  of  1882,  died 
March  21,  1922,  aged  65,  from  heart  disease. 

Dr.  Russell  Cliiford  Edwards,  jN^ewark,  Ohio,  P.  &  S.,  class  of 
1892,  died  April  13,  1922,  aged  59. 

Dr.  Clarence  Wariield,  Baltimore,  B.  M.  C,  class  of  1891,  died 
May  10,  1922,  aged  56,  from  tuberculosis. 

Dr.  Winton  M.  Xihiser,  Hagerstown,  Maryland,  P.  &  S.,  class  of 
]^82,  Bellevue  Hospital  Medical  College,  New  York,  class  of  1885, 
died  June  17,  1922,  from  a  bullet  wound  of  the  head,  aged  63. 

Dr.  John  C.  Wise,  Washington,  D.  C,  Medical  Director,  U.  S. 
Xavy,  Washington  University  School  of  Medicine,  class  of  1869, 
died  June  13,  1922,  aged  73,  He  entered  the  ISTavy  as  assistant  sur- 
geon, April  28,  1870,  and  retired  October  7,  1910;  was  fleet  surgeon 
on  the  Baltimore  of  the  Asiatic  Squadron  from  1897  to  1899,  par- 
ticipating in  the  Battle  of  Manila  Bav. 

Dr.  William  C.  McCurdy,  Philadelphia,  P.  &  S.,  class  of  1874, 
died  May  20,  1922,  aged  Q6. 

Dr.  D.  J.  Reinhart,  Baltimore,  Maryland,  class  of  1871,  died 
August  14,  1922,  aged  77. 

Dr.  George  W.  Barkman,  Govans,  Marvland,  P.  &  S.,  class  of 
1881,  died  Julv  12,  1922,  aged  71. 

Dr.  George  M.  Bell,  Wakefield,  X.  C,  P.  &  S.,  class  of  1880,  died 
May  18,  1922,  aged  Q6. 

Dr.  Lawrence  Whiteford  Settles,  Camden,  S.  C,  P.  &  S.,  class  of 
18^5,  died  June  26,  1922,  aa-ed  69. 


114 

Dr.  Christopher  (\  Hersman,  Pittsburgh,  Pa.,  P.  &  S.,  class  of 
1884,  formerly  lecturer  on  mental  and  neiTous  diseases  at  the  Uni- 
versity of  Pittsburgh,  died  April  30,  1922,  aged  68. 

Dr.  Ambrose  Augustine  Keeley,  Fall  River,  Mass.,  P.  &  S.,  class 
of  1905,  died  April  5,  1922,  aged  51,  from  dilatation  of  the  heart. 

Dr.  Charles  H.  Barron,  Rocky  Mount,  ^.  C,  class  of  1868,  died 
March  17,  1922,  aged  82. 

Dr.  Eugene  Rogers  Albaugh,  Glenville,  Pa.,  P.  &  S.,  1875,  died 
April  22,  1922,  aged  67,  from  chronic  nephritis. 

Dr.  Edward  Steptoe  King,  Sharpesburg,  N.  C,  class  of  1889,  died 
April  11,  1922,  aged  59,  from  cerebral  hemorrhage. 

Dr.  Charles  Albert,  Rockville,  Md.,  class  of  1872,  died  July  23, 
1922,  aged  69,  from  heart  disease. 

Dr.  Milton  C.  Hunter,  Champion,  Pa.,  P.  &  S.,  1882,  died  August 
4,  1922,  aged  72,  from  pneumonia. 

Dr.  Preston  B.  Loftin,  Beauford,  K  C,  class  of  1888,  died  re- 
cently, aged  60,  from  carcinoma  of  the  stomach. 

Dr.  Philip  Adolphus,  Chicago,  class  of  1858,  one  of  our  oldest  and 
most  distinguished  alumni,  emeritus  professor  of  clinical  gynecology 
at  Rush  Medical  College,  Chicago,  Civil  War  veteran,  for  33  years 
superintendent  of  the  Central  Free  Dispensai-y,  consulting  physician 
to  the  Presbyterian  Hospital,  died  August  26,  1922,  aged  94,  from 
broncho-pneumoni  a . 

Dr.  James  M.  White,  Covina,  California,  class  of  1879,  died  July 
12,  1922,  aged  64,  from  paresis. 

Dr.  Joseph  William  Kelley,  I^ewark,  :N".  J.,  P.  Sz  S.,  class  of  1897. 
a  captain  in  the  medical  corps  of  the  TJ.  S.  A.,  during  the  War,  died 
August  20,  1922,  aged  48. 

Dr.  Robert  P.  Morehead,  Weldon,  Is^.  C,  P.  &  S.,  class  of  1895, 
(lied  August  15^  1922,  aged  52. 

Dr.  Levi  Allen  Is^eiman,  Brooklyn,  I^.  Y.,  B.  M.  C,  class  of  1897, 
died  August  25.  1922.  aged  60,  from  streptococcic  septicemia  and 
oudnoarditis. 

BOOK  REVIEWS. 
The  Practice  of  ]\redicine.     By  A.  A.  Stevens.  M.  D.,  Profes.sor 
of  Applied  Therapeutics  in  the  University  of  Pennsylvania: 
Professor  of  Therapeutics  and  Clinical  Medicine  in  the  Wo- 
man's Medical   College  of  Pennsylvania.     Octavo  of  110»3 
pages.     Philadelphia  and  Loudon:  W.  B.  Saunders  Company. 
1922.     Cloth,  $7.50  net. 
Most  text-books  are  poorly  balanced.     They  are  either  too  fulsome 
or  too  skimpy  for  student  and  general  practitioner's  uses.    Ste^^ens  has 
struck  a  happy  medium  giving  sufficient  weight  to  the  important  and 
less  important  subjects  alike.     During  recent  years  many  problems 
have  l-)eset  the  profession,  some  of  which  have  been  definitely  solved 


115 

whilst  others  vet  remain  to  reveal  their  secrets.  Moot  points  to  a 
hu'ge  extent  have  been  avoided  and  only  material  of  use  to  the  intelli- 
gent practice  of  internal  medicine  incorporated.  Those  looking  for 
an  excellent  survey  of  tlie  present  status  of  present  day  medicine 
treated  from  the  view'point  of  one  engaged  in  tlie  alleviation  of  sick- 
ness will  find  their  wish  gratified  by  this  book.  It  encompasses  the 
infectious  diseases,  intoxications,  food  deficiency  diseases,  disorders 
of  metabolism,  diseases  of  the  digestive  tract,  of  the  respiratory  and 
circulatory  systems,  of  the  kidneys,  independent  diseases  of  the 
blood-forming  organs  and  the  anemias,  the  hemorrhagic  diastheses, 
maladies  of  the  spleen,  ductless  glands,  joints  and  bones, 'disturb- 
ances of  the  nervous  system,  etc:  It  is  a  sane,  every-day  book  for 
every -day  doctors,  thoroughly  reliable,  dependable  and  usable. 

Applied  Chemistry.     By  F.  X.  Peters,  Ph.  D.,  Instructor  in  Chemis- 
try in  Central  High  School,  Kansas  City,  Mo.,  for  twenty- 
three  vears;  more  recentlv  vice-principal.     Illustrated.     St. 
Louis:  C.  V.  ]\[osby  Compi^ny,  1922.     Cloth,  $3.50  net. 
In  this  book  Peters  presents  the  chemical  facts  of  every  day  life 
in  a  most  interesting  and  entertaining  and  instructive  manner.     It 
presents  in  a  simple  form  the  basic  laws  of  chemistry  making  them 
readily  gTaspaWe  to  those  desirous  of  getting  an  insight  into  the 
principles    of    chemistry.      As    an    initiation    into   the   insight    into 
chemical  reactions  it  will  be  found  thoroug'lily  trustworthy  and  de- 
l>eiidal)le.     It  gives  us  much  pleasure  to  recommend  it  to  the  good 
graces  of  those  l>eginning  the  study  of  this  most  important  subject. 

Principles  and  Practice  of  X-Ray  Technic  for  Diagnosis.  By  John 
A.  Metzger,  M.  D.,  Roentgenologist  to  the  School  for  Gradu- 
ates of  ^[edicine.  Medical  Department,  Fniversity  of  Cali- 
foniia.  Southern  Division,  Los  Angeles.  With  61  Illustra- 
tions. St.  Louis:  C.  V.  ^NFosby  Company.  1022.  Cloth,  $2.75 
net. 

Beginners  and  wc^^rkers  in  the  X-ray  will  find  this  little  manual  of 
much  value  in  enabling  them  to  master  the'  technic  of  position  and 
exjwsure.  The  illustrations  are  most  instructive.  Beginners  will 
fin<l  it  of  material  assistance  in  improving  the  quality  of  their  work. 

Practical   Infant   Feeding.      By  Lewis  Webb  Hill.  M.   D.,  Junior 
Assistant  Physician  to  the  Children's  Hospital,  Boston ;  As- 
sistant  in  Pediatrics,   Harvard  Medical   School.      Octavo  of 
483   pages,   illustrated.      Philadelphia   and   London:   W.   B. 
Saunders  C<nnpany,  1022.     Cloth,  $5.00  net. 
This  Ix^ok  concerns  itself  with  the  modern  ideas  on  infant  feeding. 
The    complicated    measures    of   the   yesterday    have    given    way    to 
^■•iiiiplcr  and  uKtre  I'ractical  methods  which  any  practitioner  can  carry 


116 

out  in  his  daily  rounds.  In  a  few  words  the  object  of  this  book  is 
To  make  toward  a  more  intelligent  feeding  of  infants.  This  the 
author  hopes  to  accomplish  bv  inculcating  in  those  feeding  infants  a 
knowledge  of  the  chemistry  of  metabolism  in  the  normal  and  ab- 
noimial  bab}' ;  in  brief  to  supply  a  satisfactory  working  knowledge. 
It  is  a  clear  concise  presentation  of  the  subject,  by  one  who  has  had 
a  wide  experience  in  the  feeding  of  the  babe,  set  forth  in  simple 
language,  containing  many  valuable  suggestions.  It  is  with  mucli 
pleasure  that  we  commend  it  to  our  readers  as  a  thoroughly  reliable 
guide. 

Tuberculosis  in  Childhood  and  Infancy.     Lectures  delivered  at  the 
Children's  Hospital,  Philadelphia,  under  the  auspices  of  the 
Pediatric  Society.     By  J.  Claxton  Gittings^  M.  D.,  Professor 
of  Pediatrics  in  the  Graduate  School  of  Medicine,  University 
of  Pennsylvania;  Visiting  Physician  at  the  Children's  Hos- 
pital,  Philadelphia;   x^ssistant   Pediatrist  at  the  University 
Hospital,  and  Frank  Crozer  Knowles,  M,  D.,  Professor  of 
Dermatology  in  the  Jefferson  Medical  College ;  Clinical  Pro- 
fessor of  Dermatology^  in  the  Women's  College ;  Dermatologist 
to  the  Presbyterian  and  Children's  Hospital ;  Chief  of  the 
Skin  Dispensary  in  the  Pennsylvania  Hospital  and  Astley 
P.  C,  Ashhurst,  M.  D.,  Associate  Professor  of  Surgery,  School 
of  Medicine,  University  of  Pennsylvania..     With  23  Illustra- 
tions.    Philadelphia  and  London :  J.  B.  Lippincott  Companv, 
1922.     Cloth,  $5.00  net. 
Though  childhood  is  especially  susceptible  to  the  ravages  of  the 
tubercle  microbe,  no  one  book  has  been  devoted  especially  to  this  side 
of  pediatrics,  therefore  this  book  should  be  most  welcome  to  those 
engaged  in  the  management  of  children.     It  considers  the  types  of 
tubercle  bacilli  and  their  relative  importance,   childhood  infection 
and  immunity,  methods   of  dissemination  and  modes  of  infection. 
A  chapter  is  devoted  to  the  general  principles  of  diagnosis  of  tuber- 
culosis, from  the  carefully  elicited  history  to  the  complete  examina- 
tion, including  also  constitutional  symptoms  which  are  more  or  le^s 
common  to  all  forms  of  the  disease.     It  gives  detailed  instructions 
for  the  application  of  the  various  tuberculin  tests.     Tuberculosis  of 
the  cervical   lymph  nodes,    of  the  upper  respiratory   tract,   of  the 
bronchial  nodes,  pleura   and  heart,  of  the  skin,  of  the  abdominal 
cavity  and  the  genito-urinary  tract,  of  the  bones  and  joints  and  of 
disseminated  tuberculosis  are  thoroughly  discussed  from  the  stand- 
point of  the  practitioner.     It  is  replete  with  many  helpful  points  in 
symptom atolog;^',  differential  diagnosis  and  treatment,  as  they  con- 
cern the  special  systems  involved  as  well  as  from  the  point  of  view 
of  the  management  of  the  tuberculous  child.     The  book  is  eminently 
practical  and  contains  all  that  is  worthwhile  in  the  mangement  and 
diasmosis  of  tuberculosis  in  the  voung. 


117 

Diseases  of  the  Skin.     By  Heniy  H.  Hazen,  A.  B.,  M.  D.,  Professor 
of   Dermatology  in  the  IMedical  Department  of  Goorgeto\m 
Fniversity;  Professor  of  Dennatolog;\'  in  the  Medical  Depart- 
ment of  Howard  University;  Sometime  Assistant  in  Derma- 
tology in   the  Tohns  Uopkiiis  Fniversity,      Second   Edition. 
241  Illustrations,  including  two  plates  in  Color.     St.  Louis: 
C.  V.  Mosby  Company,  1022.     Cloth,  $7.50  net. 
The  student  and  general  practitioner  will  tind  the  present  edition 
of  Hazen's  "Diseases  of  the  Skin,"  the  same  useful  and  helpful  book 
as  its  immediate  predecessor.    It  is  a  thoroughly  practical  book  which 
goes  into  the  subject  of  skin  lesions  in  sufficient  detail  for  those 
engaged  in  the  practice  of  medicine  or  those  desirous  of  obtaining  a 
working  knowledge  of  the  subject.     A  particularly  attractive  feature 
of  this  edition  is  the  large  number  of  well  executed  illustrations. 
Amongst  the  diseases  treated  in  this  edition  l>ut  not  mentioned  in  the 
first  are:       Disturbances  due  to  the  Vegetative  Nervous   System; 
Xaevus  iVnemicus  and  the  retention  cyst  of  the  lip.    It  gives  us  much 
pleasure  to  recommend   the  book  to   our  readers  as   a  thoroughly 
reliable,  modern,  and  dependable  treatise. 

Clinics  of  George  W.  Crile,  M.  D.,  and  Associates  at  the  Cleveland 

Clinic,  Ohio.      The  Thyroid  Gland.     Octavo  of  228  pages, 

with   106   illustrations.      Philadelphia   and   London :   W.   B. 

Saunders  Company,  1922.     Cloth,  $5.00  net. 

Crile  and  his  associates  have  had  such  a  vast  experience  in  thyroid 

maladies  that  whatever  they  have  to  say  is  of  the  utmost  value  to  the 

surgeons  and   physicians   of  this  as  well   as  other  countries.      The 

present  volume  represents  only  today's  viewpoint  of  these  writers. 

They  realize  that  our  knowledge  of  the  thyroid  is  still  in  a  period  of 

flood  and  ebb  and  must  of  necessity  undergo  changes  in  the  future. 

In  the  present  volume  these  points  are  stressed : 

(1 )   Endemic  goiter  is  a  geologic  deficiency  due  to  lack  of  iodin  in 

the  organism. 
(2  )  By  the  proper  administration  of  iodine  to  the  pregnant  mother, 
and  to  the  child  up  to  and  tlrough  the  period  of  adolescence, 
endemic  goiter  may  be  prevented ;  that  is  to  say,  the  children  of 
goitrous  regions  may  be  as  goiter  free  as  are  the  children  of 
the  seashore. 
(o)   After  the  twenty-fifth  year  of  age  iodin  exerts  little  or.  no 

beneficial  effect  on  goiters. 
C4)   By  the  improper  use  of  iodine  or  thyroids  products  many  cases 
of  quiescent  goiter,  especially  of  the  adenomatous  type,   are 
comerted  into  exophthalmic  goiter  or  hyperthyroidism. 
(  r. )    Induced  hyperthyroidism  is  essentially  identical  with  spontane- 
ous hyperthyroidism. 
(f\ )    About  30%  of  all  malignant  tnuiors  of  the  thyroid  arise  in  the 
fetal  adenomata,  hence  cancer  of  the  thyroid,  in  the  offspring. 


118 

(7)  Colloid  goiters,  colloid  adenomata,  and  adenomata  in  patients 
with  normal  sensitization  and  normal  metabolism  may  l^e  cm- 
sidered  as  simple  or  quiescent  goiters. 

(8)  ITyperthyroidism  may  be  associated  with  a  colloid  goiter  (rare  i . 
colloid  adenoma,  or  h^'perplasia.  Hyperthj^roidism  presents  no 
uniforinly  specific  pathology  of  the  thyroid  gland. 

(0)  With  certain  exceptions  the  increased  sensitization  of  the  nr- 
ganism  due  to  hyperthyroidism  is  manifested  by  abnormal 
nen'ousness,  tachycardia,  tremors,  increased  basal  metabolism, 
and  loss  in  weight. 

(10)  With  certain  exceptions  increased  sensitization  due  to  hyper- 
thyroidism is  specifically  exaggerated  by  the  injection  of  adre- 
nalin (Goetsch  test). 

(11)  Basal  metabolism  estimation  provides  a  valuable,  but  not  a 
specific  test  for  the  presence  of  hyperthyroidism.  Basal  metab- 
olism estimations  are  of  value  in  the  differential  diagnosis  of 
borderline  cases,  but  are  of  little  value  in  the  determination  of 
the  oj)erability  or  prognosis  of  cases  of  hyperthyroidism. 

(12)  In  a  small  group  of  cases  goiter  may  cause  myocarditis  and. 
hypertension  withottt  involving  the  nervous  system. 

(13)  That  the  body  is  an  electrochemical  mechanism  in  which  the 
electric  conductivity,  hence  oxidation,  is  controlled  by  the 
thyroid. 

(14)  That  the  electric  conductivity  of  certain  active  tissues  and 
organs  is  increased  by  iodine.  Therefore  in  all  cases  of  hyper- 
thyroidism or  hyperiodism  the  same  tissues  would  not  be  equal- 
ly infltienccd,  but  in  some  cases  one  and  in  others  another  tis- 
sue would  show  the  greater  alteration,  thus  producing  such 
various  types  of  disease  as  the  exophthalmic  type,  "toxic 
adenoma,"  the  myocardial  and  the  cardio-vascular  types. 
Graves'  disease.  Gull's  disease,  Basedow's  disease,  exophthalmic 
goiter,  toxic  adenoma  are,  at  best,  loose  and  unsatisfactory 
terms. 

(15)  That  hyperthyroidism  is  an  intracellular  acidosis  which  is  over- 
come by  restoring  the  normal  acid-alkali  balance.  This  is  ac- 
complished by  the  subcutaneous  infusion  of  from  3000  to  5000 
ce.  of  water;  by  digitalizing  the  heart;  by  bhxvd  transfusion, 
and  by  rest. 

(I^i)  Any  case  lip  to  the  beginning  of  dissolution  is  operable,  or  may 
be  made  operable  by  a  short  period  of  active  treatment. 

(17)   Preliminary  ligations  are  made  in  about  40'  <  of  the  cases. 

(IS)  The  average  reaction  following  ligation  is  practically  the  same 
as  the  reaction  which  follows  admission  to  the  hospital. 

flO)  Hot-water  injections,  quinine  and  urea  injections.  X-ray  or 
radium  are  no  longer  ttsed;  instead  is  substituted  a  planned 


119 

regimen  of  rest  and  diet  just  as  if  no  operation  had  been  per- 

foi-med. 
(20)   In  view  of  the  surgical  results  surgical  treatment  is  advised  for 

all  cases  without  regard  to  the  degree  of  hyperthyroidism. 
Among  the  contributor  to  the  volume  are  Graham  on  the  "Diseases 
and  Pathology  of  the  Thyroid  Gland" ;  Phillips,  ''Cardiac  Disturb- 
ances Associated  with  Disease  of  the  Thyroid  Gland" ;  Waugh,  "The 
Relation  Between  Diseases  of  the  Thyroid  Gland  and  Laryngeal 
Function" ;  Dinsmore,  "Adrenalin  Sensitization  Test  for  Hyperthy- 
roidism" ;  Xichols,  "The  Role  Played  by  the  Radiologist  in  the  Diag- 
nosis of  Goiter" ;  Christie,  "The  Value  of  Basal  Metabolism  Studies 
in  Exophthalmic  Goiter" ;  Crile,  "Surgery  vs.  X-ray  in  the  Treat- 
ment of  Hyperthyroidism" ;  Crile  and  Lower,  "The  Technic  of  Oper- 
ations on  the  Thyroid  Gland" ;  and  Gibson,  "The  Postoperative 
Treatment  of  the  Exophthalmic  Goiter  Patient. 

Xaturally  the  book  is  a  very  valuable  contribution  as  are  all  from 
the  Cleveland  Clinic  and  should  prove  most  useful  to  those  engaged 
in  the  management  of  thyroid  patients. 

The  Writing  of  Medical  Papers.     By  Maud  H.  Mellish,  Editor  of 
the  Mayo  Clinic  Publications.     12  mo.  of  157  pages.    Phila- 
delphia and  London:  W.  B.  Saunders  Company,  1922.   Cloth, 
$1.50  net. 
This  little  book  fills  a  long  felt  need  in  the  medical  literature. 
Every  page  is  full  of  helpful  suggestions  to  those  engaging  in  the 
writing  of  medical  pajDers.    It  will  be  found  especially  useful  to  those 
who  have  not  mastered  the  art  of  good  composition.     It  emphasizes 
what  is  and  what  is  not  good  English,  what  is  accepted  as  good  form 
and  what  as  poor.     Going  directly  as  it  does  to  the  heart  of  the  sub- 
ject, it  should  prove  of  infinite  service  in  making  for  better  con- 
structed and  expressed  medical  papers. 

Svmptoms  of  Visceral  Disease.     A  Study  of  the  Vegetative  Xervous 
Svstem  in  its  Relationship  to  Clinical  Medicine.    By  Francis 
M.  Pottenger,  A.  M.,  M.  D.,  LL.  D.,  F.  A.  C.  P.,  Medical 
Director,   Pottenger  Sanatorium  for  Diseases  of  the  Lungs 
and  Throat,  Monrovia,  California ;  Author  of  Clinical  Tuber- 
culosis,   Tuberculin    in    Diagnosis    and    Treatment,    Muscle 
Spasm   and  Degeneration,   etc.     Second  Editiou.     "With   8(; 
Text  Illustrations  and  10  Color  Plates.     St.  Louis:  C.  V. 
Mosby  Company,  1922.     Cloth,  $5.50  net. 
This  monograph  interprets  in  terms  of  visceral  neurology,  symp- 
toms which  are  found  in  the  daily  clinical  observation  of  viscera] 
disease.     It  shows  how  pathologic  lesions  in  one  organ  affects  othev 
organs  and  the  body  as  a  whole,  through  the  medium  of  the  visceral 
iieiwes.     Unlike  most  books  of  this  sort  wdiich  engage  in  the  discus- 


120 

fion  of  disease  processes  from  perverted  anatomical  relationships,  this 
is  a  study  in  disturbed  physiological  processes.  As  such  it  leads  into 
a  study  of  the  problem  concerning;  the  sympathetic  nervous  system. 
Throughout  the  book  Pottenger  endeavors  to  impress  upon  the  readei- 
the  importance  of  learning  to  interpret  symptoms  correctly,  to  study 
the  patient  and  not  to  make  of  him  a  walking  laboratory.  He  states 
(^orrectly  medicine  can  only  be  advanced  by  the  observation  of  the 
patient  and  not  placing  entire  dependence  upon  the  laboratory  find- 
ings. He  states  during  recent  years  the  laboratory  has  attained  too 
great  an  ascendency  over  the  clinical  side  of  medicine  and  emphasises 
the  laboratory  report  is  just  as  liable  to  be  incorrect  as  the  deductions 
derived  from  a  careful  study  of  the  case,  citing  in  substantiation 
thereof  concrete  examples.  If  the  book  does  no  more  than  influence 
its  readers  to  return  to  the  patient  as  the  basis  of  their  investigations 
it  has  served  a  most  useful  purpose. 

Surgical   and    Mechanical    Treatment   of   Peripheral   ISTei-ves.      By 
Byron  Stookey,  M.   D.,  Associate  in  N^eurology,   Columbia 
University;  Assistant  Professor  of  Neurology,   New  York 
Post-Grraduate  Medical  School  and  Hospital.    With  a  chapter 
on  Nerve  Degeneration  and  Regeneration  by  G.  Carl  Huber. 
M.  D.,  Professor  of  Anatomy,  TTniversity  of  Michigan.     Oc- 
tavo volume  of  475  pages  with  217  illustrations,  8  in  colors 
and  20  charts.     Philadelphia  and  London :  W.  B.  Saunders 
Company.  1922.     Cloth,  $10.00  net. 
With  the  oncoming  of  the  Great  War  nerve  surgery  received  a 
great  impetus  and  was  greatly  advanced  by  the  obsei'vations  of  those 
engaged  in  this  phase  of  War  surgeiy.     Many  old  notions  were  found 
wanting  and  dispensed  with,  until  at  last  some  sort  of  order  has 
evolved  out  of  what  was  formerly  a  mass  of  unproven  theories.     This 
book  is  devoted  to  the  expostulation  of  the  principles  and  methods 
Avhich  have  been  found  of  value.    The  anatomy,  embryology  and  phy- 
siology of  the  peripheral  nerA^ous  system  have  all  been  called  upon 
liberally  by  the  author  to  elucidate  the  principles  underlying  an  in- 
telligent treatment  of  the  peripheral  nerve  lesions.     Considerable  at- 
tention has  been  gi^-en   also  to  the  fallacies  of  certain  practices  in 
nerve  surgery  with  an  idea  of  indicating  their  futility  and  to  hasten 
their  discardment.      The  author  emphasizes  especially  our  present 
knowledge  of  the  surgical  and  mechanical  treatment  of  peripheral 
nerve  lesions.  .  Those  interested  in  the  present  state  of  development 
and  of  the  management  of  peripheral  nerve  lesions  will  find  in  this 
book  a  most  conservative  exposition  of  the  subject  as  it  is  known  at 
the  r>resent  time. 


UNIVERSITY  OF  MARYLAND 

BULLETIN 

OF  THE 

SCHOOL  OF  MEDICINE 

Vol.  VII.  JANLTARY,  1923.  ]^o.  3 


REORGANIZATION  OF  THE  UNIVERSITY  HOSPITAL. 

By  a.  F.  Woods, 
Freddent  of  the  University  of  Maryland. 

No  medical  college  can  do  satisfactory  teaching  without  the  aid 
of  a  modern  and  well  equipped  hospital  conducted  for  the  specific 
purpose  of  the  educational  work.  The  University  Hospital  has 
long  served  this  purpose  for  the  Medical  School  of  the  University 
of  Maryland. 

The  need  for  greater  hospital  facilities  is  pressing  and  as  already 
pointed  out  by  Gordon  Wilson  in  the  Bulletin,  Vol.  V,  No.  3,  Octo- 
ber, 1920,  an  effort  has  been  made  to  raise  the  funds  necessaiy  for 
this,  purpose.  Only  enough  was  secured  to  build  a  part  of  the 
Nurses'  Home.  This  is  now  completed  and  constitutes  the  first 
unit  of  the  new  plant.  It  is  fireproof  and  modern  in  every  respect. 
The  Training  School  for  Nurses  bears  a  close  relation  to  the 
Hospital.  The  lack  of  modern  facilities  adds  greatly  to  the  diffi- 
culties, as  well  as  to  the  cost  of  maintaining  the  Hospital. 

There  is  urgent  need  for  an  adequate  fireproof  hospital,  with 
laboratories  and  out-patient  departments.  General  plans  for  these 
are  under  consideration  and  it  is  hoped  that  the  State  may  provide 
for  them  in  the  near  future. 

The  general  plan  and  policies  to  be  followed  in  the  reorganiza- 
tion under  the  Consolidation  Act  was  presented  in  the  Bulletin  in 
articles  prepared  at  my  request  by  Gordon  Wilson,  Vol.  V,  No.  4, 
December,  1920,  and  in  a  brief  article  I  wrote  for  the  same  num- 
ber. The  larger  features  of  the  reorganization  were,  of  course, 
accomplished  by  the  terms  of  the  Act  itself.  This  provided  that 
all  property  rights  and  control  should  pass  to  the  State  of  Mary- 
land and  that  the  Board  of  Trustees  of  the  Maryland  State  Col- 
lege should  become  the  Board  of  Regents  of  the  University  of 
^faryland,  with  all  the  powers  granted  by  both  charters. 

When  this  Act  was  passed  the  Board  of  Trustees,  now  the  Board 
of  Regents,  had  already  adopted  a  comprehensive  plan  of  develop- 
ment for  the  Maiyland  State  College,  which  included  an  Agricul- 


122 

tiiral  gi'oup,  an  Arts  and  Science  gi'oup,  an  Engineering  group 
an  Education  group,  and  a  Home  Economics  group,  each'with  its 
appropriate  departments  and  curriculum  leading  to  appropriate 
degrees.  The  general  building  plan  bad  been  adopted  and  appro- 
priations requested  and  in  part  granted  by  the  previous  Legislature 
and  in  part  included  in  the  Budget  Bill  for  the  first  biennium  fol- 
lowing the  consolidation.  For  the  first  two  years,  therefore,  that 
is,  up  to  October  1,  1922,  only  the  orginal  appropriations  granted 
to  the  old  University  have  been  available  for  the  Baltimore  Schools. 
These  were  sufficient  to  keep  the  Medical  School  in  Class  A  and 
provided  nothing  for  the  Hospital,  except  part  pay  for  State  pa- 
tients, $22,500,  which  amount  fell  short  of  paying  the  cost  of 
these  patients  by  over  $35,000  a  year.  N'othing  was  provided 
for  Dentistry,  Phannacy  or  Law. 

An  effort  was  made  to  secure  outside  aid  from  sources  that  we 
had  good  reason  to  believe  would  help,  at  least  in  the  Medical 
group,  but  this  came  to  nothing.  A  general  appeal  to  the  public 
was  out  of  the  question,  owing  to  the  general  financial  conditions 
and  the  numerous  drives  that  had  exhausted  the  supplies  available 
from  such  sources.  It  became  necessary,  therefore,  to  operate  the 
institution  on  the  small  appropriation  available  from  the  State  and 
the  usual  fees  and  the  donations  received  through  the  Women's 
Auxiliary. 

A  careful  audit  of  the  books  showed  that  the  Medical  School 
and  Hospital  had  large  cash  deficits  amounting  to  about  $40,000 
each,  due,  in  the  case  of  the  Medical  School,  largely  to  the  purchase 
of  real  estate  needed  by  the  University,  and  in  the  case  of  the 
Hospital,  to  the  excess  in  cost  of  State  patients  over  the  amount 
appropriated.  In  both  cases,  also,  the  cost  of  maintenance  was 
and  still  is  excessive  owing  to  inadequate  equipment.  The  cost  of 
nursing  has  been  especially  high,  due  to  the  fact  that  student  nurses 
were  unwilling  to  accept  the  living  conditions  which  were  so  un- 
satisfactory^ that  we  could  not  wait  for  the  completion  of  the  new 
Nurses'  Home,  but  had  to  better  them  from  hospital  receipts. 
Nurses  had  to  be  hired  to  make  up  the  lack  of  student  nurses  and 
the  compensation  to  student  nurses  had  to  be  largely  increased. 
Some  urgent  repairs  and  new  equipment  had  to  be  provided  or 
close  the  Hospital.  The  money  for  these  things  has  been  secured 
only  through  the  strictest  business  management  and  I  fear  in  at 
least  some  cases  economies  that  could  not  be  considei'ed  good  busi- 
ness management. 

I  know  that  in  doing  this  we  have  made  some. mistakes,  but  these 
are  inevitable  in  such  a  process.  All  have  done  the  best  they  could 
under  the  cireunistanoes.  ^lucli  that  i?  still  urgently  needed 
cannot  be  undertaken  because  of  lack  of  funds.     An  effort  was 


123 

made  at  the  last  session  of  the  Legislature  to  secure  additional 
appropriations  to  meet  these  most  urgent  needs  of  the  Univexsity. 
The  recommendations  of  the  Governor  in  his  Budget  were  cut  by 
the  Ways  and  Means,  and  Finance  Committees,  but  nevertheless 
substantial  progress  has  been  made,  in  that  the  Senators  and  Rep- 
resentatives generally  have  a  better  knowledge  of  and,  therefore, 
gi-eater  interest  in  the  work  the  University  is  doing. 

Owing  to  plans  that  had  been  formulated  and  approved  before 
the  consolidation  certain  buildings  at  College  Park  had  to  be  pro- 
vided. In  addition  to  these,  provision  was  made  for  the  installa- 
tion of  a  refrigerating  plant  in  the  University  Hospital  and  for  the 
equipment  of  the  new  ISTurses'  Home,  as  well  as  for  some  equip- 
ment for  Dentistry,  and  Pharmacy.  The  latter  will  be  used  in 
fitting  up  the  old  church  adjoining  the  Dental  and  Pharmacy 
laboratories  on  the  north,  which  makes  it  possible  to  accommodate 
about  fifty  additional  students  in  Dentistry. 

Of  the  items  allowed  in  the  maintenance  budgets  the  General 
University  appropriation  will  take  care  of  items  amounting  to 
$35,000  a  year  for  the  Hospital,  Medical  School,  Dentistry  and 
Phannacy.  With  this  aid  it  is  hoped  to  clear  up  the  $40,000 
deficit  in  the  Hospital  during  the  biennium  and  reduce  the  deficit 
in  the  Medical  School  and  also  provide  for  certain  necessary  Arts 
and  Science  subjects  in  Dentistry  and  Pharmacy. 

Two  years  from  now  we  hope  that  all  urgent  needs  of  the  Uni- 
versity will  be  provided  for  by  the  State.  There  is  little  doubt 
that  this  will  be  done  if  the  people  of  the  State  and  the  members 
of  the  Legislature  come  to  know  what  the  University  is  doing  and 
can  do  for  them  in  rendering  service  urgently  needed  and  not 
otherwise  obtainable.  The  co-operation  of  all  friends  of  the  Uni- 
versity to  this  end  is  essential. 

So  far  as  funds  available  will  permit,  the  general  plan  of  re- 
organization outlined  briefly  in  the  Bulletin,  Vol.  V,  No.  4,  De- 
cember, 1920,  is  being  carried  out.  It  may  be  of  interest  to  quote 
from  the  statements  there  made : 

"Standard  pre-medical  courses  and  courses  in  arts  and  science 
are  available  in  the  Arts  and  Science  Schools  at  College  Park  for 
those  desiring  to  prepare  for  the  Medical  College.  Scientific  spe- 
cialists in  the  College  Park  laboratories  and  departments  are  avail- 
able for  special  work  in  the  laboratories  in  Baltimore.  Most  of 
the  work  of  the  pre-clinical  years  is  available  on  both  campuses. 
The  laboratories  will  be  developed,  equipped  and  manned  for 
thorough  teaching  and  research,  with  a  corps  of  the  best  full-time 
men  available  and  such  part-time  men  as  are  needed  for  efficient 
work.  The  aim  in  all  departments  is  to  bring  in  the  best  men 
from  the  best  universities  to  get  the  inspiration  and  larger  univer- 


124 

sity  viewpoint  that  comes  from  such  association,  and  to  avoid  the 
ill-effects  of  too  much  'inbreedino-,' 

"The  clinical  departments  also  will  be  headed  eventually  by  tlie 
best  men  available  on  at  least  a  'part-time'  basis.  This  should 
make  the  places  attractive  to  the  very  best  type  of  men.  Such  ad- 
ditional part  and  full-time  men  as  are  necessary  to  accomplish  the 
best  work  will  make  up  the  staff  of  each  department. 

"Fitness  for  the  work  will  be  the  only  consideration  that  will 
weigh  in  these  appointments,  which  will  be  made  by  the  President 
after  conference  with  the  deans  and  heads  of  departments. 

"A  short  time  prior  to  the  United  States  becoming  a  participant 
in  the  World  War  the  Faculty  of  Physic  of  the  University  of 
Maryland  unanimously  recommended  that  the  department  of  in- 
ternal medicine  be  reorganized  and  placed  under  the  charge  of  a 
well-paid,  properly  trained  internist,  who  should  devote  four  hours 
every  day  to  teaching  and  hospital  work.  They  further  recom- 
mended that  the  sub-departments  of  internal  medicine  should  be 
under  the  charge  of  the  professor  of  medicine,  and  that  he  should 
be  entirely  responsible  for  the  arrangement  and  direction  of  all 
medical  teaching,  and  that  he  should  have  the  power  to  recommend 
all  appointments,  promotions  and  removals,  that  the  free  wards  of 
all  hospitals  should  be  under  his  control  as  far  as  concerned  med- 
ical patients,  that  he  should  have  charge  of  the  medical  dispen- 
saries and  the  use  of  this  material  for  teaching  purposes,  with  the 
power  also  to  appoint  and  displace  those  working  in  the  medical 
branches  of  the  dispensary'.  He  was  also  to  have  the  power  of 
appoanting  all  medical  interns  and  could  suspend  or  discharge  them 
with  the  approval  of  the  Faculty,  and  the  further  power  was  given 
him  of  finally  grading  all  students  in  the  Department  of  Medicine, 
subject  to  the  approval  of  the  Faculty. 

"On  account  of  the  above  recommendation,  which  I  endorse 
most  heartily,  I  deemed  that  this  department  should  be  reorgan- 
ized at  once,  as  no  further  study  was  required,  and  it  was  only 
necessary  to  obtain  the  funds  to  carry  out  the  reorganization  and 
to  find  the  proper  man  who  should  head  this  department."  This 
has  been  accomplished. 

The  organization  and  management  of  the  Hospital  so  that  it  will 
be  most  effective  in  the  training  of  physicians  and  nurses  requires 
a  clear  and  definite  fixing  of  responsibility  on  the  part  of  those  in 
charge  of  the  several  departments,  as  well  as  provisions  for  the 
fullest  co-operation.  This  requires,  first,  a  general  Superinten- 
dent or  Director,  responsible  to  the  President  of  the  University; 
a  Superintendent  or  Director  of  the  Nurses'  Training  School,  re- 
sponsible either  directly  to  the  President  or  through  thf  Dean  of 
the  Medical  School,  for  the  educational  work,  and  to  the  Super- 


125 

intendent  of  the  Hospital  for  the  nursing  work  done  in  the  Hos- 
pital, This  plan  is  now  in  operation.  In  order,  however,  that  the 
general  policies  of  the  Hospital  and  Training  School  may  have 
most  careful  consideration,  it  has  been  thought  wise  to  appoint  an 
advisory  council.  At  my  request  the  Chairman  of  the  Board  of 
Regents,  the  Dean  of  the  Medical  School,  the  head  of  the  Depart- 
ment of  Surgery,  and  the  head  of  the  Department  of  Medicine 
have  acted  as  a  temporary  council.  The  Superintendent  of  the 
Hospital,  the  Superintendent  of  jSTurses  and  the  Comptroller  have 
attended  most  of  the  meetings.  It  is  planned  to  select  two  lay 
members  entirely  outside  the  institution  and  two  members  nomi- 
nated by  the  visiting  staif,  and  also  a  representative  of  the  Wom- 
en's Auxiliary.  Any  suggestions  as  to  a  better  plan  are  heartily 
welcomed.  Constructive  criticism,  as  well  as  commendation,  is 
invited  at  all  times.  Only  in  this  way  shall  we  be  able  to  work 
out  a  perfected  organization. 

Such  suggestions  and  criticisms  should  be  made  to  the  respon- 
sible officials,  such  as  heads  of  departments,  superintendents,  deans 
or  the  President.  It  is  unnecessary,  of  course,  to  say  that  criticism 
of  the  University  to  people  not  responsible  for  it  or  to  those  who 
are  not  in  a  position  to  correct  things  that  are  wrong  and  those 
who  may  be  looking  for  something  to  find  fault  with  is  not  con- 
structive and  will  not  be  indulged  in  or  encouraged  by  any  friend 
of  the  University. 


Al^   ANALYTICAL   STUDY   OF   EXTRACRANIAL 

ANEURISM  OF  THE  INTERNAL  CAROTID 

ARTERY  OF  SPONTANEOUS  ORIGIN. 

By  Nathan  Winslow. 

(From  the  Surgical  Departmient  of  the  University  of  Maryland.) 

In  this,  the  second  instalment*  of  my  aerial  on  extracranial 
aneurism  of  the  internal  carotid  artery,  I  have  attempted  to  assem- 
ble all  of  the  examples  of  this  lesion  recorded  in  the  literature  as 
spontaneous.  I  realize  that  some  cases  may  have  been  inadver- 
tently overlooked.  In  an  investigation  of  this  character  covering 
as  it  does  many  languages,  oversights  are  inevitable.  The  cases 
cited  fall  naturally  into  two  groups :  (1)  Those  subjected  to  some 
foim  of  radical  arterial  surgery  (Table  1)  ;  (2)  Those  which  were 
not  (Table  2).  The  former  number  25;  the  latter  14.  The  con- 
dition is  of  interest  not  only  on  account  of  the  obscurity  enveloping 

*First  instalment.  Bulletin  School  of  Medicine,  University  of  Mary- 
land, 1922,  vii,  84. 


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139 

it,  wlieii  it  does  occur;  but  also  because  of  the  many  mistakes  in 
diagnosis  which  have  led  to  the  inadvisable  use  of  the  lancet  with 
unfortunate  results.  Such  accidents  have  been  only  too  frequent 
and  exemplify  the  importance  of  regarding  as  aneurism,  until 
proven  otherwise,  every  unilateral  swelling  located  in  the  neigh- 
borhood of  the  tonsil.  By  adopting  this  precaution  the  medical 
attendant  may  avoid  the  embarrassment  of  opening  an  aneurism 
for  an  abscess. 

The  cases  number  39 ;  of  which  28  were  women;  10  were  men, 
and  1  was  a  child  with  sex  not  given.  These  figures  are  just  the 
reverse  of  the  usual  order  of  events,  as  eneurism  elsewhere  is  by 
far  more  prevalent  in  the  male  than  in  the  female.  As  to  the  why 
or  wherefore  for  this  turnabout,  I  can  offer  no  explanation ; 
I  can  only  submit  the  result  of  my  investigation.  The  ages  were 
434,  8,  19,  19,  23,  23,  24,  26,  28,  28,  30,  32,  35,  36,  38,  38,  40, 
40,  41,42,  44,  47,  48,  50,  58,  58,  58,  60,  60,  60,  60,  63,  65,  74,  75 
and  76  years  respectively.  In  two  the  patients  were  simply  de- 
scribed as  women ;  in  one  as  a  child.  The  right  side  was  affected 
17  times;  the  left  18,  not  stated  4.  16  recovered;  18  died  and  5 
were  unimproved.  25  were  operated  upon.  Of  these,  9  (36%) 
died;  and  16  (64%)  were  cured.  The  operative  fatalities  were 
given  as  follows :  hemorrhage,  3  times ;  cerebral  complications,  1 ; 
hemiplegia,  2 ;  on  the  operating  table  from  spontaneous  rupture 
of  sac  into  mouth  and  asphyxia,  1 ;  sepsis,  1 ;  and  no  assignable 
cause,  1.  14  cases  were  not  operated  upon,  with  9  deaths  or  a 
mortality  of  64.28%;  the  remaining  5  (35.72%)  were  unim- 
proved when  discharged.  ISTo  spontaneous  recoveries  were  re- 
ported. These  figures  are  a  potent  argument  for  radical  arterial 
intervention  in  this  lesion.  The  deaths  in  the  unoperated  cases 
were  attributed  to  hemorrhage,  6  times;  coma,  1;  cerebral  symp- 
toms, 1;  undetermined,  1.  The  imposition  of  almost  insurmount- 
able anatomical  difficulties  to  direct  attack  upon  the  sac  renders 
ligation  of  the  common  carotid  alone  or  in  combination ;  or  of  the 
internal  carotid  alone  when  the  circumstances  are  propitious,  the 
operations  of  choice.  Once  only  was  aneurismorrhaphy  attempted, 
with  death  of  the  patient  from  secondary  hemorrhage  at  the  suture 
line. 

The  vessels  ligated  and  the  results  were : 

Common  carotid;  13  times,  with  8  cures  and  5  deaths. 

Common  and  external  carotids ;  2  times,  both  patients  were 
cured. 

Common  and  external  carotids  and  superior  thyroid ;  once,  with 
cure. 

Common  carotid,  repeated  with  division  5  months  later  for  re- 
turn: 1,  cured. 


140 

Common,  internal  and  external  carotids ;  once  with  cure. 

Common  and  internal  carotids ;  once,  with  cure. 

Common,  external  and  internal  carotids  with  extirpation  of  sac ; 
1,  died. 

Common  and  internal  carotids,  above  and  below  sac  and  extir- 
pation of  sac ;  once,  cured. 

Common  carotid,  superior  thyroid,  lingual  and  opposite  common 
carotid;  once,  with  death. 

Common  carotid,  repeated  later  the  same  day  and  in  addition 
the  external  and  internal  carotids  and  superior  thyroid ;  once,  with 
death. 

Common  carotid  and  plugging  of  hole  in  an  orbital  sac  with  a 
piece  of  cork,  opened  accidentally,  on  account  of  two  aneurisms, 
one  in  the  neck,  and  one  partly  within  the  cranium  and  partly 
orbital ;  once,  with  cure. 

Chassaignac  lanced  a  retropharyngeal  swelling  for  abscess,  but 
fortunately  cured  the  patient  by  ligation  of  the  common  carotid 
artery.     Dubrueil  mistook  a  pharyngeal  swelling  for  sarcoma  and 
during  an  attempt  at  enucleation  tore  the  sac  wall.     The  escaping 
blood  was  arrested  by  a  ligation  of  the  common,  internal  and  exter- 
nal carotids  and  the  superior  thyroid  arteries,  but  the  patient  died 
14  days  later  of  hemiplegia.     Helferich  had  the  same  accident 
befall  him,  but  fortunately  saved  his  patient  by  a  ligation  of  the 
common  and  internal  carotids.     Hulbert  was  saved  a  similar  fate 
when  he  inserted  a  needle  into  the  sac  and  withdrew  pure  blood. 
Though  Agnew  ligated  both  common  carotids  and  the  superior 
thyroid  and  lingual  arteries  on  the  side  of  the  lesion,  the  current 
was  re-established  in  the  internal  carotid,  with  rupture  of  the  sac 
and  death  from  sepsis.     The  case  of  Jianu's  is  very  extraordinary. 
There  were  two  aneurisms  in  the  course  of  the  internal  carotid,  one 
cervical  and  the  second  projecting  from  within  the  cranium  into 
the  orbit  and  presenting  at  the  naso-orbital  junction.     During  an 
attempt  to  enucleate  the  latter  Jianu  tore  the  sac  wall.     To  con- 
trol the  escaping  blood  he  inserted  a  finger  into  the  hole  and  then 
proceeded  to  ligate  the  common  carotid.     As  there  was  still  some 
oozing  from  the  rent  after  this  was  accomplished,  Jianu  invagi- 
nated  the  sac  wall  with  a  piece  of  cork  and  sutured  the  skin  over  it 
to  keep  it  in  place.     Happily  the  patient  recovered.     Radical 
arterial  surgery  needs  no  further  brief  than  64%  cures  against 
none  when  dilatory  tactics  were  employed.    Another  lesson  taught 
by  these  studies  is:  in  the  presence  of  an  unilateral  pharvngeiil 
swelling  before  puncture  listen,  feel  and  touch.     Amongst  others 
Minich  reported  a  case  which  the  attending  physician  had  lanced 
for  abscess.    With  difficulty  the  hemorrhage  was  checked  but  two 
davs  later  recurred  and  could  not  be  arrested.    In  this  case  neither 


141 

pulsation  nor  fluctuation  was  felt.  Wagner  was  spared  a  like 
experience  by  forgetting  to  take  along  his  instruments.  When  he 
returned  the  next  day  he  was  told  the  patient  had  died  during  the 
night  of  hemorrhage  from  the  mouth, 

Vander  Veer  believed  he  had  effected  a  cure  by  digital  compres- 
sion of  the  common  carotid  artery,  but  three  months  after  the 
initiation  of  the  treatment,  the  man  fell  dead.  Edmunds  refrained 
from  operation  because  examination  caused  giddy  spells  and  faint- 
ness.  The  cases  of  Perier,  Pircher,  Coomes  and  WagTier  are  a 
grim  reminder  that  death  ever  threatens  from  spontaneous  rupture 
of  the  sac  into  the  mouth  when  the  proper  surgical  measures  are 
withheld. 

Though  not  confined  to  the  internal  carotid,  a  case  of  aneurism 
involving  all  three  carotids  reported  by  Walshman  (Proo.  Roy. 
Med.  and  Surg.  Trans.,  Lond.,  1899,  3  s.,  xii,  71;  Med.  and  Surg. 
Trans.,  Lond.,  1899  Ixxxii,  223)  merits  notice  here.  The  patient 
was  a  man,  forty-nine  years  old,  with  the  complaint  of  a  swelling 
in  the  right  side  of  the  neck  of  six  years'  duration.  The  growth 
was  the  size  of  a  cricket  ball,  globular,  hard  and  extended  from 
the  jaw  almost  to  the  clavicle.  It  did  not  pulsate,  and,  until  op- 
eration, was  suspected  as  a  malignant  tumor.  A  trocar  was  in- 
serted into  the  lump,  but  failed  to  evacuate  blood.  There  was  no 
bulging  in  the  throat,  no  dyspnea,  no  dysphagia.  The  operation 
done  December  5,  1895,  consisted  of  ligation  of  the  common,  ex- 
ternal and  internal  carotids  and  enucleation  of  the  sac.  The  pa- 
tient was  cured.  In  the  University  Magazine,  1889,  i,  340, 
DeaVer  cites  a  similar  experience.  The  patient,  a  man,  aged  46, 
consulted  Deaver  in  1888  for  a  swelling  in  the  right  side  of  the 
neck  of  20  years'  duration.  It  was  stated  all  three  carotids  were 
involved  in  the  dilatation.  The  common  carotid  artery  was  tied 
in  the  inferior  carotid  triangle,  Septeraber  25,  1888.  A  complete 
cure  ensued.  Prosser  (Br.  Med.  Jl.  1897,  i,  530)  and  Langen- 
buch  (Reunion  libre  des  chir.  de  Berl.,  Seance  du  14  Dec,  1891, 
in  Mercredi  med.,  1892,  iii,  21)  report  cases  that  have  been 
cited  as  aneurism  of  the  internal  carotid  artery,  but  owning  to 
insufficient  evidence,  have  been  omitted  from  the  tabulation. 
Pro'sser  showed  a  woman,  aged  70,  at  the  February  17,  1897, 
meeting  of  the  ^Midland  Medical  Society.  She  had  for  a  num- 
ber of  years  a  pulsating  tumor  in  front  of  the  right  ear.  Pul- 
sation disappeared  after  ligation  of  the  common  carotid  artery, 
and  the  swelling  diminished,  but  before  very  long  reappeared. 
Considerable  hemorrhagic  oozing  occurred  from  the  swelling,  but 
was  controlled  by  the  local  application  of  styptics.  In  the  year 
1890,  a  woman,  aged  66,  presented  herself  at  Langenbuch's  clinic 
with  a  pulsating  tumor  occupying  the  left  lateral  portion  of  the 


142 

neck.  A  souffle  was  audible.  Touch  showed  it  a  fusiform  dilata- 
tion of  the  interaal  and  external  carotids.  Ligatioii  was  not  prac- 
tised because  of  the  age  of  the  patient.  An.  attempt  was  made 
merely  to  narrow  the  lumen  of  the  vessel  by  means  of  a  silk  liga- 
ture so  as  to  lessen  but  not  interrupt  the  current  of  blood.  Fol- 
lowing this  procedure  the  pain  and  pulsation  were  less  intense. 

Ludwig  Meyer  (Archiv.  f.  Psychiatric,  Berl.,  1875,  vi,  84)  in 
an  article  entitled  "Ueber  aneurysmatische  Veraenderungen  der 
Carotis  interna  Geisterkranker,"  reports  what  he  believes  eight 
examples  of  aneurism  of  the  extra-cranial  portion  of  the  internal 
carotid  artery.  All  of  the  obsei-vations  were  made  at  autopsy  upon 
mentally  deranged  patients.  From  the  solitary  illustration  fea- 
turing the  article  and  the  subject  matter  of  the  text,  the  condi- 
tion appears  rather  to  have  been  a  slight  thickening  of  the  arterial 
wall  at  its  point  of  origin.  Shaefer  (Allgemeine  Zeitsft.  f. 
Psychiat.  u.  Psychisch-Gerichtliche  Medic,  1887,  4  s.,  xxxiv,  483) 
in  an.  article,  Ueber  die  aneurysmatische  Erweiterung  der  Caro- 
tis interna  an  ihren  Ursprung,"  following  the  lead  of  Meyer  de- 
scribes the  same  condition  as  aneurism.  Macfarlan  (Jour,  of  Oph- 
thal.,  Otol.  and  Laryngol.,  1920,  xxiv,  390)  does  not  offer  suffi- 
cient proof  to  justify  the  acceptance  of  his  cases  as  aneurisms  of 
the  cervical  portion  of  the  internal  carotid  artery.  The  first  ob- 
sei'vation  concerned  a  woman,  aged  58,  who  sought  relief  for  a 
whistling  noise  in  the  right  ear  of  two  years*  duration,  which 
kept  her  awake  at  night.  Listening  in  the  region  of  the  right  ear 
Macfarlan  heard  a  slight  systolic  murmur,  synchronous  with  the 
pulse.  The  neck  did  not  pulsate.  The  author  thought  the  con- 
dition due  to  an  extracranial  aneurism  of  the  internal  carotid,  lo- 
cated near  the  base  of  the  skull.  The  second  patient,  a  woman, 
aged  62,  first  complained  of  eai-  noises  in  March,  1920.  These 
became  gradually  worse  and  prevented  sleep.  May  8th  a  slight 
])ulsation  was  seen  in  the  upper  part  of  the  neck  in  front  of  the 
left  stemo-cleido-mastoid  muscle.  Listening  over  this  area  with  a 
stethoscope  a  faint  bruit  was  heard.  It  was  blowing  and  in 
unison  with  the  pulse.  The  disability  was  attributed  to  an  aneur- 
ism of  the  upper  portion  of  the  common  carotid  artery  or  of  the 
litginning  of  the  interaal  carotid.  On  the  other  hand,  though 
wanting  in  data,  the  case  of  Hodgson's,  related  by  Partridge  (Lan- 
cet, Lond.,  1842,  i,  86(i)  in  the  discussion  of  Liston's  address,  has 
every  appearance  of  being  a  genuine  aneurism  of  the  internal  caro- 
tid. The  patient  was  a  child  9  years  old,  with  involvement  of  all 
rliree  coats  of  the  artery. 

The  cases  of  Hunter  and  Marchal  quoted  by  Wyeth  (Trans. 
Amer,  Med.  Assoc,  1878,  xxix,  Prize  Essay,  appendix,  pp.  58 
and  56)  though  very  suggestive,  could  not  be  confinned.    Hunter's 


143 

patient  was  a  woman,  aged  60,  with  an  aneurism  in  the  mouth,  for 
which  ligation  of  the  common  carotid  artery  was  practised  August 
3,  1843,  followed  four  days  later  by  death.  On  the  other  hand, . 
Marchal  opened  an  aneurism  for  an  abscess.  To  arrest  the  bleed- 
ing he  ligated  first  the  external  carotid  artery  but  did  not  bring  the 
hemorrhage  under  control  until  the  common  carotid  artery  was 
also  tied.  The  patient  was  a  man,  aged  25,  with  a  swelling  in  the 
left  side  of  the  throat  of  two  months'  duration.  The  operation  was 
done  June  19,  1835,  but  the  patient  died  6  days  afterwards  of 
cerebral  complications  (Norris :  The  American  Jour,  of  the  Med. 
Sc,  1847,  n.  s.,  xiv,  14). 


KETROSPECT  ANl)  PROSPECT. 

By  Randolph  Winslow,  M.  D.,  LL.  D. 

(President's  Address,  o4:th  Annual  Session  of  the  Southern  Surgi- 
cal Association,  Pinehurst,  N.  C,  December 
13,  14,  15,  1921.) 

Fellows  of  the  Southern  Surgical  Association  : 

For  the  great  and  unexpected  honor  of  being  your  presiding 
officer  at  this,  the  34th  annual  session,  I  tender  my  most  grateful 
thanks.  That  you  have  judged  me  worthy  of  this  distinction  is  a 
source  of  the  most  profound  satisfaction  to  me,  though  mingled 
with  the  sense  of  my  own  shortcomings ;  and  yet  in  one  respect  it 
may  not  be  inappropriate  that  I  should  be  your  president  at  this 
time,  since  I  was  born  in  this  state  and  lived  here  in  my  youth, 
during  the  stoiTay  time  of  the  Civil  War.  Although  I  have  lived 
for  more  than  a  half  century  in  the  City  of  Baltimore,  I  still  love 
the  "old  North  State,"  and  the  honor  of  being  president  of  this 
distinguished  body  is  enhanced  by  the  fact  that  this  annual  session 
is  held  in  the  state  in  which  I  first  saw  the  light  of  day.  Fifty 
years  ago  I  began  the  study  of  medicine  at  the  University  of  Mary- 
land and,  as  was  usual  at  that  time,  was  graduated  after  an  attend- 
ance on  two  short  courses  of  lectures.  Since  then  I  have  witnessed 
the  stupendous  changes  in  the  science  and  art  of  medicine  which  as 
a  panorama  has  unfolded  itself  before  my  eyes.  Anesthesia,  it  is 
true,  had  been  in  daily  use  for  25  years,  and  this  boon  had  robbed 
surgical  procedures  of  the  gTeatest  of  their  terrors ;  but  the  danger 
of  infection  was  always  present,  and  many  well  designed  and  skill- 
fully executed  operations  failed  on  this  account.     The  science  of 


144 

bacteriology  scarcely  had  been  bom  and  the  causation  of  zymotic 
diseases  was  still  enshrouded  in  mystery.  The  epoch  making  dis- 
coveries of  Pasteur  in  regard  to  fermentation  and  putrefaction, 
and  the  application  of  these  discoveries  in  a  crude  form  to  practical 
surgery  by  Lister  were  still  neither  generally  known  nor  widely 
accepted.  Under  these  circumstances  surgery  was  confined  mostly 
to  the  repair  of  injuries,  to  the  removal  of  external  tumors,  to 
ligation  of  the  more  superficial  vessels  for  aneurism  or  injury  and 
to  operations  for  strangulated  hernia.  Abdominal  surgery,  as  we 
understand  it,  was  in  its  swaddling  clothes;  and  was  confined  al- 
most entirely  to  the  removal  of  ovarian  tumors,  with  very  uncer- 
tain results. 

*  The  appendix  remained  unmolested  in  its  lair.  Gallstones  had 
been  removed  by  Bobbs,  of  Indianapolis,  in  1867,  but  his  example 
had  not  been  followed  by  many  physicians  :  and  the  stomach,  liver, 
spleen  and  pancreas  were  practically  immune  to  surgical  attack. 
The  kidneys  were  sacred  organs  and  were  considered  beyond  the 
pale  of  operative  intervention.  Operations  on  the  intestinal  tract 
were  but  seldom  undertaken  and  usually  terminated  disastrously. 
jSTor  were  the  cranial  or  thoracic  cavities  more  favorably  circum- 
stanced. Dieulafoy's  aspirator  had  recently  come  into  use  and 
efforts  to  cure  empye^ma  were  being  made  through  this  means,  but 
the  chest  was  seldom  opened  to  allow  the  escape  of  pus  or  for  anj' 
other  surgical  intervention.  The  cranium  was  trephined  for  de- 
pressed fractures  and  occasionally  for  epilepsy,  and  this  was  about 
the  limit  of  the  surgery  of  the  skull  and  its  contents.  The  thyroid 
gland  had  been  excised  a  few  times,  with  a  high  mortality,  but 
even  such  a  distinguished  and  progressive  surgeon  as  Samuel  D. 
Gross,  vehemently  condemned  the  operation  as  unwarrantable  in 
1866  and  John  Eric  Eriokson  in  1873,  also,  disclaimed  it  as  un- 
justifiable. The  mammary  gland  was  ablated  for  malignant 
growths,  but  the  axilla  was  not  cleaned  out,  nor  were  the  pectoral 
muscles  and  fasciae  removed.  Tinder  these  circumstances  a  radical 
cure  of  cancer  of  the  breast  was  well  nigh  impossible.  Even  the 
uterus  was  allowed  to  keep  its  tumors  in  peace,  and  only  the  can- 
cers of  the  cervix  received  surgical  attention.  But  it  must  not  be 
supposed  that  surgery  was  at  a  low  ebb.  There  were  many  sur- 
geons of  great  attainments  and  of  remarkable  skill,  and  much  suc- 
cessful surgical  work  was  done.  Many  operations  that  are  now 
done  in  safety  were  at  that  time  prohibited  on  account  of  the  dan- 
ger of  hemorrhage.  The  prevention  of  both  primary  and  secondary 
hemorrhage  was  very  uncertain,  and  operations  of  great  magnitude 
would  be  undertaken  with  only  -a  few  bull-dog  forceps  to  catch  the 
spirting  vessels.  Artery  clamps  such  as  are  used  at  present  had 
not  been  invented  and  hemostasis  was  very  imperfectly  aocom- 


145 

plished.  Arteries  were  tied  with  silk  and  one  end  of  the  ligature 
was  cut  close  to  the  knot,  w^hile  the  other  lon.o'  end  was  left  pro- 
truding from  the  wound.  These  unsterilized  ligatures  could  only 
be  detached  by  ulcerating  through  the  vessel  and  it  not  infrequently 
happened  that  about  the  10th  day  a  secondary  hemorrhage  would 
occur,  which  often  resulted  fatally. 

As  has  been  stated,  however,  the  greatest  obstacle  to  advanced 
surgical  work  was  infection.  Most  wound  healing  was  attended 
with  suppuration,  and  the  formation  of  a  thick  creamy  pus  was 
hailed  as  a  favorable  token,  and  was  spoken  of  as  ''laudable  pus." 
Erysipelas  also  was  not  uncommon,  and  w^as  a  menance  not  only 
to  the  success  of  the  operative  procedure  but  to  the  life  of  the 
patient  as  well ;  while  septicemia,  pyemia  and  other  grave  forms 
of  systemic  infection  were  by  no  means  infrequent.  Diagnoses 
were  chiefly  arrived  at  by  means  of  the  special  senses,  as  instru- 
ments of  precision  were  but  few.  The  clinical  thermometer  was 
in  daily  use  and  the  microscope  was  available  for  the  examination 
of  urine  and  other  secretions,  as  w^ell  as  for  the  examination  of 
morbid  tissues,  but  unfortunately  there  were  but  few  who  could 
use  it.  The  esophagoseope,  bronchoscope  and  cystoscope  were  not 
yet  invented,  nor  were  the  X-rays  and  their  wonderful  properties 
discovered  until  about  a  score  of  years  later. 

The  causation  of  diseases  was  equally  unknown ;  and  it  was  a 
decade  later  that  Koch  announced  the  discovery  of  the  tubercle 
bacillus ;  and  that  Laveran  and  others  showed  that  malaria  was 
due  to  a  parasite  in  the  blood.  With  the  development  of  the  science 
of  bacteriology  the  secrets  of  the  ages  began  to  yield  to  the  re- 
searches of  the  investigators,  and  disease  was  found  to  be  due  to 
microorganisms  rather  than  to  some  inscrutable  act  of  divine 
P.rovidence.  With  the  recognition  of  the  part  played  by  germs  in 
wound  infection  came  the  attempt  to  prevent  infection  by  destroy- 
ing the  germs  both  before  and  after  their  lodgement  in  the  wounds, 
and  this  was  the  era  of  the  carbolic  spray  and  the  irrigation  of 
wounds  with  strongly  carbolized  solutions.  While  the  results  were 
nmch  improved  by  this  means,  which  was  known  as  antiseptic  sur- 
gery, it  was  found  that  many  serious  disasters  followed  the  use 
of  carbolic  acid  on  raw  surfaces.  Irrigations  of  wounds  with  cor- 
rosive sublimate  solutions  did  not  give  much  better  results,  and 
gradually  the  use  of  strong  chemical  agents  in  wounds  was  dis- 
continued. The  era  of  aseptic  surgery  was  now  ushered  in,  which 
lias  continued  to  the  present  time.  By  aseptic  methods  we  mean 
the  sterilization  of  everything  that  will  come  in  contact  with 
wounded  surfaces  before  such  wounds  have  been  made,  rather  than 
the  attempt  to  kill  germs  in  wounds  after  they  have  gained  en- 
trance thereto'.     In  1873  the  surgical  world  was  thrilled  by  the 


14:6 

flunouueemeiit  of  the  successful  extirpation  of  the  laryux  by  Bill- 
roth, and  again  in  1881  when  the  same  brilliant  surajeon  success- 
fully resected  the  pylorus.  In  1881,  also,  the  illustrious  J.  Marion 
Sims,  leaving  his  special  field  of  gynecology,  devoted  the  last  days 
of  his  life  to  advocating  the  operative  treatment  of  penetrating 
wounds  of  the  abdomen.  In  1884  William  T.  Bull  opened  the  ab- 
domen for  gunshot  wounds  of  the  intestines  successfully  and  thus 
established  practically  Sims'  theoretical  opinion  in  regard  to  the 
treatment  of  these  hitherto  fatal  injuries.  It  is  not  so  well  re- 
membered however,  that  our  own  fellow,  R.  A.  Kinloch,  operated 
successfully  for  gamshot  of  the  intestines  in  1862.  Lawson  Tait 
at  or  about  this  same  time  was  operating  successfully  for  pus  tubes 
and  for  other  intra-abdominal  conditions,  which  up  to  then  had 
neither  been  accurately  recognized  nor  successfully  treated.  In 
1886  Reginald  H.  Fitz  published  his  observations  on  inflamma- 
tions in  the  right  iliac  region  of  the  abdomen.  This  opened  the 
way  for  the  development  of  the  surgery  of  the  appendix,  which 
has  been  followed  with  such  brilliant  results.  This  brings  us  to 
the  time  of  the  organization  of  this  association.  Let  us  pause  for 
a  moment  to  consider  the  state  of  medical  atfairs  in  the  South 
soon  after  the  close  of  the  Civil  War.  The  South  was  absolutely 
impoverished  and  many  of  its  ablest  physicians  and  surgeons  mi- 
grated to  the  cities  of  the  North,  where  they  soon  achieved  repu- 
tation and  prosperity;  but  many  others  remained  in  their  na- 
tive land,  where  they  ministered  to  their  people  "without  much 
thought  of  any  substantial  reward.  They  had  neither  the  time 
nor  the  money  to  permit  them  to  attend  medical  conventions  in 
remote  places.  The  American  Medical  Association  was  the  only 
national  society  at  that  time,  and  its  meetings  were  quite  small ; 
but  as  soon  as  the  disturbed  condition  of  the  country  became  more 
settled  other  national  societies  began  to  spring  up.  Thus  the 
American  Gynecological  Association  was  organized  in  1876,  and 
the. American  Surgical  Association,  the  last  work  of  the  revered 
Gross,  was  founded  in  1880.  The  honors  of  this  association  were 
quite  impartially  distributed,  however,  as  in  the  first  ten  years  of 
its  existence  four  surgeons  from  the  South  occupied  the  pi'esiden- 
tial  chair — ^W^illiam  T.  Briggs  of  I^ashville,  Hunter  McGuire  of 
Richmond,  David  W.  Yandell  of  Louisville,  and  'Claudius  H.  Mas- 
tin  of  Mobile.  But  the  leaders  of  surgical  thought  in  the  South- 
ern States  did  not  think  that  this  association  afforded  a  sufficientl.\' 
broad  field  for  the  needs  of  the  Southern  surgeons,  and  hence  the 
Southern  Surgical  and  Gynecological  Association  was  founded  on 
October  12,  1887.  •  Article  II  of  the  constitution  adopted  in  1888 
says:  ''The  object  of  this  association  shall  l>e  to  organize  the 
profession  of  the  South  in  the  most  efiicient  manner  possible  for 


147 

the  advancement  of  the  sciences  of  surgery  and  o-ynecolog'y"' ;  and 
President  William  D.  Haggard,  the  father  of  our  distinguished 
fellow  and  ex-president  William  D.  Haggard,  Jr.,  in  his  inaugural 
address  said:  "The  Southern  Surgical  and  Gynecological  Asso- 
ciation did  not  spring  voluntarily  into  existence,  but  was  the  out- 
growth of  necessity  and  is  the  embodiment  of  unknown  power." 

From  these  quotations  we  see  that  the  original  reason  for  the 
organization  of  this  association  was  the  imperative  need  of  the 
physicians  and  surgeons  of  the  South  for  instruction  in  surgical 
science  and  for  association  with  the  leaders  of  surgical  thought. 
The  expression  of  the  first  president  that  the  association  is  "the 
embodiment  of  unknown  power"  comes  down  to  us  as  a  prophecy, 
of  which  we  now  see  the  fulfillment.  We  now  know  that  the 
eft'ect  of  the  action  of  the  founders  of  this  society  has  been  to  de- 
velop as  able  a  body  of  surgeons  as  can  be  found  anywhere  in  this 
country  or  abroad,  and  to  greatly  sitimulate  the  science  of  sur- 
gery throughout  this  country. 

The  second  president  of  this  association  was  Hunter  McGuire, 
beloved  and  revered  in  the  South  and  honored  throughout  the 
whole  country,  whose  distinguished  son,  Stuart  McGuire,  has  also 
followed  in  the  footsteps  of  his  father  and  has  served  acceptably 
as  president  of  this  bod.y.  Dr.  Hunter  ^EcGuire  in  his  presi- 
dential address  in  1889  said,  "Let  our  motto  be  lofty  aim  and 
united  action.  As  Southern  men  let  us  show  the  world  that,  under 
changed  conditions,  we  have  still  the  stamina  of  our  forefathers. 
As  members  of  our  beloved  profession,  let  us  strive  to  be  first  in 
scientific  attainment,  first  in  integrity,  first  in  high  purpose  for 
the  good  of  mankind."  This  was  a  high  standard  to  be  set  as 
the  object  of  an  organization  which  was  in  its  infancy  and  which, 
at  that  time,  was  limited  in  its  membership  to  surgeons  of  the 
foimer  Confederate  States.  But  has  not  the  inspiration  been  at- 
tained ?  J  think  it  has  to  a  very  large  degree.  The  aim  of  this 
association  hasi  always  been  lofty  and  its  scientific  work  has  been 
such  as  to  stimulate  not  only  the  surgeons  of  the  South,  but  those 
of  the  other  sections  of  our  country  as  well,  to  exert  their  best 
efi'orts  for  the  good  of  mankind. 

The  first  annual  meeting  was  held  in  Birmingham,  Alabama, 
on  December  4,  5  and  6,  1888,  at  which  there  were  41  members 
in  attendance  and  50  guests.  The  members  were  all  from  the  12 
Southern  States,  including  Kentucky.  Of  these  Drs>.  J.  D.  S. 
Davis,  John  W.  Long,  L.  S.  McMurtry-,  F.  W.  Parham,  Isaac  S. 
Stone,  H.  M.  Taylor  and  W.  F.  Westmoreland,  Jr.  remain  with 
us  today  as  honored  fellows  of  this  association. 

Papers  were  presented  by  Dr.  Westmoreland,  Jr.,  on  "Treat- 
ment of  Fractures  with  Plaster  of  Paris  Splints"  ;  by  Dr.  J.  D.  S. 


148 

Davis,  on  "Electrolysis  in  Morbid  Alterations  Produced  in  the 
Prostate  by  Gonorrhoea  of  the  Urethra" ;  by  Dr.  J.  Wesley  Long 
on  "Practical  Aseptic  Surgery,"  and  by  Dr.  Isaac  S.  Stone  on 
"The  Field  and  Limitation  of  Laparotomy."  all  of  them  valuable 
contributions  to  very  live  problems. 

The  Southern  Surgical  and  Gynecological  Association,  however, 
could  not  long  remain  a  strictly  local  society,  and  soon  we  find 
surgeons  from  other  parts  of  the  L^nion  seeking  its  membership, 
until  for  a  long  time  past  it  has  been  a  national  society  in  every- 
thing but  name.  It  is  true  that  the  bulk  of  its  membership  comes 
from  the  South  in  accordance  with  the  constitution,  Article  IT 
of  which,  as  amended  in  1890,  reads  "The  object  of  this  associa- 
tion is  to  further  the  study  and  the  practice  of  surgery  and  gyne- 
cology among  the  profession  of  the  Southern  States" ;  but  what  an 
arra,y  of  illustrious  names  of  former  and  present  fellows  from 
every  section  of  our  country  are  inscribed  upon  its  roster. 

From  Portland,  Maine,  to  Porlland,  Oregon ;  from  Boston  to 
Galveston ;  from  Minneapolis  to  l^ew  Orleans ;  from  Chicago  to 
Jacksonville ;  from  l^ew  York  to  San  Francisco,  and  from  Atlantic 
City  to  Los  Angeles,  surgeons  whom  we  delight  to  honor  have  hon- 
ored us,  and  honored  themselves,  by  seeking  fellowship  with  us. 

Among  so  many  distinguished  Fellows  now  with  us  it  would  be 
an  ungracious  act  to  name  any  single  individual  as  deserving  of 
especial  praise,  but  this  does  not  hold  good  for  those  who,  having 
wrought  mightly  in  their  day,  now  rest  from  their  labors.  In  the 
early  days  of  the  association,  when  it  was  doubtful  whether  it 
would  live  or  die,  the  great  influence  of  our  second  president,  Dr. 
Hunter  McGuire  of  Richmond  Va.,  was  a  strong  factor  in  plac- 
ing it  on  a  solid  foundation  and  in  giving  it  the  scientific  standing 
which  has  continually  increased  to  the  present  day,  The  prosper- 
ity of  the  association  was  also  much  enhanced  by  the  work  of  Dr. 
W.  E.  B.  Davis  of  Birmingham,  Ala.,  who  was  its  secretary  from 
its  organization  in  1887  until  1900,  and  its  president  in  1902. 
In  fact,  we  have  been  highly  fortunate  in  our  secretaries,  having 
had  but  three  in  the  thirty-four  years  of  the  existence  of  the  so- 
ciety. Among  other  notable  fellows  who  greatly  added  to  the 
reputation  of  the  Association  may  be  mentioned  Richard  Douglas 
of  ISTashville,  John  B.  Murphy  of  Chicago,  Joseph  Price  of  Phila- 
delphia, Louis  McLane  Tiffany  of  Baltimore,  Maurice  Richard- 
son of  Boston,  Roswell  Park  of  Buffalo,  Joseph  Ransohotf  of  Cin- 
cinnati and  George  Ben  Johnston  of  Richmond,  all  of  whom  have 
now  passed  to  the  great  majority.  We  honor  them  for  their  ac- 
complishments and  we  miss 'them  at  our  annual  gatherings.  In 
looking  through  the  Transactioais  I  have  been  greatly  impressed 
with  the  gi'eat  variety  of  subjects  presented  by  the  authors  and 


149 

the  full  and  valuable  discussions  thereon.  A  veritable  epitome  of 
the  pro^^-ess  of  suro-ery  is  to  be  foTind  in  these  yearly  publications. 

Moreover,  the  initial  purpose  of  the  Association  has  been  ful- 
filled. The  surgeons  of  the  South  no  longer  require  any  special 
tutelage  in  surgery  or  gynecology,  but  are  the  peers  of  their  col- 
leagues the  world  over.  They  are  the  legitimate  successors  of 
those  wonderful  pioneers  of  the  past,  Ephraim  McDowell,  the 
father  of  ovariotomy ;  Crawford  W.  Long,  the  first  to  use  ether  as 
an  anesthetic,  and  J.  Marion  Sims,  the  father  of  modem  gyne- 
cology; besides  a  host  of  others  whose  achievements,  while  not  sa 
outstanding,  have  added  much  to  the  relief  of  suffering  and  the 
prolongation  of  human  life.  They  were,  however,  more  skilled 
with  the  scalpel  than  with  the  pen,  and  their  deeds  were  slow  in 
getting  into  print  and  in  securing  for  their  authors  that  recogni- 
tion to  which  they  were  entitled. 

Our  infant  association  has  now  developed  into  full  maturity  and 
has  acquired  adult  strength.  Its  object  is  no  longer  limited  to  the 
development  of  the  study  and  practice  of  surgery  in  the  South, 
but  extends  to  all  parts  of  our  country.  It  is  a  national  society. 
In  what  way  can  its  influence  and  usefulness  be  increased  ?  First, 
by  exercising  gTeat  care  in  the  election  of  fellows.  Dr.  Bedford 
Brown,  in  his  presidential  address  in  1893,  said  the  membership 
included  three  classes  of  physicians : 

1.  Specialists  in  surgery  and  gynecology'. 

2.  Eminent  practitioners  who  did  some  surgery  and  gynecology. 

3.  Young  surgeons  of  promise  who  had  not  yet  reached  promi- 
nence. 

While  this  classification  may  have  been  necessary  in  the  early 
(lays  of  the  Association,  it  is  now  neither  necessary  nor  proper, 
and,  in  fact,  is  no  longer  observed.  In  my  opinion  the  fellowship 
should  consist  of  specialists  in  surgery,  including  gynecology,  who 
have  obtained  prominence  in  their  profession  by  their  work  and 
by  their  contributions  to  surgical  literature.  There  are. many  ex- 
cellent surgeons  who  operate  successfully  but  who  neither  write 
nor  discuss  surgical  papers.  Such  individuals  are  not  entitled  to 
become  fellows  of  this  Association.  Second,  this  Association  is 
not  a  kindergarten  for  the  development  of  fiedglings  in  surgery, 
who  have  not  yet  acquired  full  adult  plumage,  however  promising 
they  may  be ;  and,  in  my  opinion,  a  period  of  8  or  10  years  should 
have  elapsed  from  the  time  of  graduation  before  they  should  be 
eligible  for  election  to  fellowship  in  this  society.  Third,  fellows 
who  do  not  attend  the  meetings  and  present  papers  at  least  once 
in  three  years  are  mere  parasites  and  should  be  dropfped,  unless 
some  reasonable  excuse  is  given  for  their  delinquency. 


150 

It  is  a  great  honor  to  be  a  fellow  of  this  Association,  but  with 
this  honor  goes  a  responsibility;  first,  to  live  up  to  the  highest 
ideals  of  professional  rectitude,  and  secondly,  to  contribute  to  the 
general  stock  of  surgical  knowledge.  Have  we  done  this  ?  In  the 
main  I  think  we  have.  We  have  a  large  number  of  very  active 
members  who  are  usually  found  present  at  our  meetings  and  who 
contribute  largely  to  our  programe ;  but  there  are  also  quite  a 
number  of  names  on  our  roll  of  men  who  have  absented  them- 
selves for  protracted  periods  and  who  have  not  contributed  any- 
thing to  the  interest  or  advantage  of  the  fellows  of  the  Association. 
Such  persons  are  barnacles  on  our  craft  that  ought  to  be  removed. 
As  we  have  many  more  applications  for  fellow^ship  than  can  be 
elected,  the  question  of  increasing  the  number  of  active  fellows 
naturally  comes  up  for  consideration.  I  think  it  would  be  a  mis- 
take to  do  this,  as  a  larger  number  would  be  too  bulky  for  a  so- 
ciety of  specialists,  and  would  tend  to  lessen  the  distinction  of 
fellowship  in  this  Association.  Let  our  membership  then  consist 
of  those  who  by  their  work  have  shown  that  they  are  entitled  to 
this  honor,  and  who  value  their  membership  sufficiently  to  attend 
the  meetings  regularly  and  to  contribute  to  our  scientific  proceed- 
ings. 

Many  years  ago  a  prominent  author,  I  think  it  w-as  Ericksen. 
said  surgery  had  reached  its  peak;  that  there  would  be  some  re- 
finement in,  technique,  but  surgery  could  not  advance  farther. 
Since  that  time  surgery  has  been  revolutionized  and  the  brain  and 
spinal  cord,  the  heart  and  lungs,  the  abdominal  and  pelvic  organs, 
the  thyroid  and  prostate  glands,  and  the  aorta  and  great  vessels. 
have  all  been  made  accessible  to  successful  surgical  attack,  while 
plastic  and  reparative  surgery  have  reached  a  degree  of  perfection 
not  dreamed  of  by  our  forebears  in  their  wildest  flights  of  imagi- 
nation. In  this  advance  of  surgical  science  and  art  fellows  of 
this  Association  have  played  an  important  part,  and  we  have  to 
pay  our  homage  to  those  who  are  dead,  and  to  offer  our  con- 
gratulations to  those  who  are  still  living  and  striving  in  the  inter- 
est of  their  fellow-men.  But  what  of  the  future?  Has  the  limit 
of  surgery  been  reached  'i  ISTay !  I  verily  believe  we  are  but  on 
the  threshold  of  discoveries  that  will  add  greatly  to  the  life  and 
happiness  of  the  human  race  in  the  prevention  and  cure  of  con- 
ditions which  are  now  both  unpreventable  and  incurable.  The  note 
that  I  would  wish  to  sound  is  one  of  abounding  optimism  and  of 
unbounded  faith  in  the  victorious  march  of  our  guild  to  heights 
that  have  never  yet  been  scaled  or  even  envisaged  through  the  mists 
of  the  ages.     In  this  advance  it  is  both  my  ardent  hope  and  my 


151 

earnest  expectation  that  the  Southern  Surgical  Association  shall 
take  a  leading  part. 

"Men,  my  brothers,   men,   the  workers,  ever  reaping  something 

new. 
That  which  thev  have  done  but  earnest  of  the  things  that  they 

shall  do.'' 


EDITORIAL. 

"Greater  love  hath  no  man  shown  than  this, 
that  a  man  lay  down  his  life  for  his  friends." 

Lest  we  forget,  this  is  a  slight  reminder  that  the  Buii;  J.  As- 
per  Memorial  Fund  is  still  open.  Since  the  last  announcement 
additional  contributions  have  been  received  as  follows : 

Dr.  J.  J.  Greengrass,  class  of  1911,  Patterson,  N.  J.  .  .  $15.00 

Dr.  A.  M.  Shipley,  class  of  1902,  Baltimore,  Md 10.00 

Dr.  J.  R.  Agiiew,  class  of  1914,  Ghicopee,  Mass 10.00 

Dr.  Kenneth  B.  Jones,  class  of  1911,  Univ.  Hosp.,  Balto.  S.Od 

I>r.  R.  A.  Allgood,  class  of  1912,  Fayettesville,  N.  C.  ..  5.00 

$45.00 
Previously  acknowledged 60.00 


Total $105.00 

The  appended  letter  shows  the  right  spirit : 

October  19,  1922. 
Dear  Doctor  Winslow : 

I  have  just  been  reading  the  "Bulletin''  and  wish  to  make  a 
small  contribution  to  the  Burt  J.  Asper  Memorial  Fund.  I  am 
enclosing  a  check  for  $10.00  and  sincerely  tiiist  that  a  sufficient 
amount  may  be  realized  to  establish  a  scholarship. 

J.  R.  Agnew, 
Class  of  1914. 

This  gift,  coming  as  it  did  unsolicited,  is  more  than  appreci- 
ated. If  only  a  small  proportion  of  our  alumni  would  do  like- 
wise. Dr.  Agnew's  wish  would  be  more  than  realized.  Brother 
alumni,  this  is  to  be  a  free-will  offering;  any  other  course  would 
be  unworthy  the  memory  of  Burt  J.  Asper.  Let  not  his  death  be 
in  vain,  but  perpetuate  it  with  a  memorial  which  will  serve  to  in- 
spire the  youths  of  the  future.  This  is  your  opportunity.  Are 
you  going  to  grasp  it  ( 


152 


PAUSE  AND  GIVE  HEED. 

Accordino-  to  the  latest  figures  available,  the  roll  call  of  the 
Medical  Alumni  Association  is  now  well  over  the  1,200  mark. 
This  is  fine,  but  we  will  not  be  satisfied  until  every  alumnus 
eligible  to  membership  shall  have  signed  up.  If  an  application 
blank  has  failed  to  reach  you  a  request  for  one  to  Dr.  W.  S.  Love, 
836  West  ]^orth  Avenue,  Baltimore,  will  be  attended  to  without 
delay.  The  task  of  re-creating  the  Alumni  Association,  as  the 
above  figures  attest,  is  well  under  way ;  the  job,  however,  is  a  big 
one,  and  its  successful  issue  depends  upon  your  co-operation.  Join 
up  now,  not  tomorrow,  lest  you  forget.  The  Association  is  yours 
to  mold  as  .you  wish.  As  ye  want  it,  so  shall  it  be — inert  or  ac- 
tive ;  it's  up  to  you.  If  you  have  neglected  to  answer  the  ques- 
tionaire  sent  you,  please  don't  delay  longer.  We  want  this  in- 
formation for  our  records;  we  want  it  connect  and  not  garbled. 
Do  it  now. 


DEATHS. 

Dr.  Walter  Fremont  Church,  Greeley,  Colorado,  P.  &  S.,  class 
of  1893,  and  Push  Medical  College,  class  of  1899,  a  captain  in 
the  Medical  Corps  during  the  World  War,  died  September  11, 
1922,  aged  57,  from  heart  disease. 

Dr.  Arthur  A.  Reynolds,  Scranton,  Pennsylvania,  B.  M.  C, 
class  of  1900,  died  August  15,  1922,  aged  46,  from  gastric  ulcer. 

Dr.  Levi  Allen  jSTeiman,  Brooklyn,  E".  Y.,  B.  M.  C,  class  of 
1897,  died  August  25,  1922,  aged  60,  from  streptococcic  septi- 
cemia and  endocarditis. 

Dr.  Thomas  Fleming  Lanham,  Grafton,  W.  Va.,  P.  &  S.,  class 
of  1880,  died  August  25,  1922,  aged  72. 

Dr.  George  Lee  Bowne  Jarvis,  Coopertown,  I:^.  Y.,  P.  &  S.,  class- 
of  1892,  died  September  23,  1922,  aged  53,  from  an  accidental 
gunshot  wound  of  the  abdomen.  In  1916  Dr.  Jai-vis  entered  the 
United  States  N'aval  Reserve,  and  on  America's  entrance  in  the 
World  War  was  made  assistant  surgeon  with  the  rank  of  lieuten- 
ant, junior  grade.  During  the  war  he  was  promoted  to  a  senior 
lieutenancy,  under  which  rank  he  was  retired  at  the  close  of  hos- 
tilities. 

Dr.  William  W.  Eequardt,  Baltimore.  Md..  class  of  1896,  As- 
sociate Professor  of  Surgery  in  the  University  of  Maiyland,  died 


163 

October  9,  1922,  aged  48,  from  septicemia,  a  metastasis  from  tlie 
throat. 

Dr.  John  W.  Cox,  Johnson  City,  Teun.,  P.  &  S.,  class  of  1884, 
a  veteran  of  the  Spanish-American  War,  died  October  3,  1922, 
ag'ed  64,  following-  an  attack  of  acute  indi.g'estion. 
'  Dr.  Charles  O.  Rice,  Denver,  Colorado,  B.  M.  C,  class  of  1890, 
died  October  2,  1922,  aged  64,  from  carcinoma. 

Dr.  Addison  B.  G.  Eeader,  Camden,  1^.  J.,  B.  M.  C,  class  of 
1898,  died  October  18,  1922,  aged  46,  from  heart  disease. 


BOOK  REVIEW. 

A  Manual  of  Pharmacology,  By  Tor  aid  Sollmann,  M.  D.,  Pro- 
fessor of  Pharmacology  and  Materia  Medica  in  the  School  of 
Medicine  of  Western  Reserve  University,  Cleveland.  Second 
edition,  entirely  reset.  Octavo  of  1066  pages.  Philadelphia 
and  London:  W.  B.  Saunders  Company,  1922.  Cloth,  $7.00 
net. 

Pharmacology,  like  all  other  branches  of  medicine,  has  made 
rapid  strides  during  the  past  few  years.  Many  new  drugs  have 
been  added  to  the  physician's  armamentarium,  and  some  have 
been  dropped  as  obsolete.  Those  who  desire  to  obtain  first-hand 
authorative  information  concerning  these  changes  need  only  con- 
sult Sollmann's  Manual  of  Pharmacology.  It  is  written  both  with 
a  view  to  the  needs  of  the  physician  and  the  student  becoming 
initiated  into  the  mysteries  of-  drugs.  For  the  former  a  more  de- 
tailed account  of  the  point  under  discussion  is  added  in  small 
type ;  for  the  latter,  who  is  concerned  merely  with  an  acquisition 
of  the  basic  principles,  the  matter  is  set  forth  in  bolder  type.  The 
new  drugs  and  remedies  are  emphasized  with  definite  instructions 
for  their  use.  To  the  drugs  in  general  use  most  attention  is 
given.  A  section  is  devoted  to  prescription  writing,  a  phase  of 
medicine  which  has  become  to  a  great  extent  a  lost  art.  B_y  ad- 
hering to  the  injunction  therein  set  forth  the  student  will  soon 
acquire  the  art  of  correct  prescription  writing.  In  the  appendix 
is  incorporated  besides  other  valuable  material  a  table  of  average 
doses  and  a  full  bibliography  of  the  latest  works  on  pharmacology. 
It  is  needless  to  state  that  this  edition  is  a  thoroughly  trustworthy 
guide  to  the  proper  understanding  of  and  direction  for  the  intelli- 
gent use  of  both  organic  and  inorganic  drugs.  It  gives  us  great 
pleasure  to  recommend  it  to  student  and  active  practitioners  of 
medicine. 


154 

Bronchoscopy  and  Esopha^oscopy.  A  Manuiil  of  Peroral  Endo- 
scopy and  Lai-yngeal  Surgeiy.  By  Chevalier  Jackson,  M.  D., 
Professor  of  Bronchoscopy  Esophagoscopy,  Graduate  School 
of  Medicine,  University  of  Pennsylvania ;  Professor  of 
Laryngology,  Jefferson  Medical  College.  Octavo  of  346 
pages,  with  114  illustrations  and  4  color  plates.  Philadelphia 
and  London:  W.  B.  Saunders  Company.  1922.  Cloth,  $45.50 
net. 

There  is  hardly  any  need  of  calling  attention  to  a  work  from 
the  pen  of  Chevalier  Jackson,  as  the  quality  of  his  literary  con- 
tributions have  been  for  a  number  of  years  recognized  as  of  the 
highest  order  of  merit.  For  a  long  time  Jackson  has  been  ac- 
knowledged the  master  bronchoscopician  and  esophagoscopician. 
He  is  without  peer  in  this  line,  and  his  teachings  are  devoured 
with  avidity.  'No  man  in  this  wide  world  has  done  so  much  to 
place  bronchoscopogeal  and  esophagoscopogeal  diagnosis  and  treat- 
ment upon  the  high  plane  of  perfection  it  has  attained  as  this  in- 
defatigable worker  and  scientist.  His  teachings  are  accepted 
as  the  last  word,  and  justly  so.  He  has  made  the  direct  viewing 
and  treating  of  the  esophagus  and  bronchial  tree  a  simple  measure 
to  those  who  have  taken  the  trouble  to  profit  of  his  teachings.  He 
has  made  it  possible  to  remove  from  these  structures  foreign 
bodies  with  the  least  degree  of  danger  to  the  patient,  and  this  un- 
der the  direct  vision  and  control  of  the  operator,  so  that  today 
it  is  inexcusable  to  open  the  chest  or  neck  to  recover  objects  ac- 
cidentally aspirated  into  these  tracts.  However,  it  must  not  be 
suraiised  that  the  insertion  of  either  the  esophageal  or  bronchial 
canula  is  without  danger,  for  pitfalls  are  ever  lurking  for  the  un- 
wary and  uninitiated.  It  is  with  -these  problems  that  this  mono- 
graph is  concerned.  It  is  invaluable  to  the  specialist  in  this  field, 
encompassing  as  it  does  the  years  of  experimental  work  and  prac- 
tical application  thereof  by  Jackson  to  the  direct  viewing  of  the 
food  and  air  passages.  It  tells  what  can  and  what  cannot  be  ex- 
pected of  this  instrument  of  precision ;  how  and  how  not  to  use 
it.  The  author  is  of  the  opinion  that  any  foreign  body  of  ap- 
preciable size  that  has  gone  down  through  the  natural  passages 
can  be  removed  bronchdscopically  the  same  way,  provided  fatal 
trauma  is  avoided.  At  his  clinic  98,7%  of  foreign  bodies  have 
been  thus  removed.  Specialists  cannot  afford  to  be  without  it : 
others  can  read  it  with  much  profit. 


155 

Physical  Diagiiosis.  By  W.  D.  Rose,  M.  D.,  Lecturer  on  Phy- 
sical Diagnosis  and  Associate  Professor  of  Medicine  in  the 
('niversity  of  Arkansas;  Visiting  Physician  Little  Rock  City 
Hospital,  Baptist  Hospital  and  St.  Vincent's  Infirmary,  Lit- 
tle Rock,  Arkansas.  Third  edition.  Three  hundred  and 
nineteen  illustrations.  St.  Louis:  C.  V.  Mosby  Company, 
1922.     Cloth,  $8.50  net. 

This  book  presents  most  excellently  those  features  of  physical 
diagnosis  needed  by  the  student  in  grasping  the  science  of  making 
a  diagnosis.  It  is  well  illustrated ;  the  diction  is  clear  and  force- 
ful and  the  matter  is  well  ordered  and  leads  up  gradually  from 
the  simpler  to  the  more  complex  without  jarring  the  sensibilities 
of  the  reader.  An  attractive  feature  of  the  book  is  the  brief  sec- 
tion devoted  to  the  clinical  pathology  of  the  lesion  under  discus- 
sion. This  tends  to  simplify  the  subject  and  to  prepare  the 
ground  for  a  better  understanding  of  the  matter  imder  discussion. 
The  book  is  thoroughly  modem  in  tone  and  contains  the  last  word 
on  the  proper  way  of  going  about  making  a  proper  examination 
of  the  organs  of  the  chest  and  abdomen.  Both  students  and  gen- 
eral practitioners  of  medicine  will  find  it  an  invaluable  aid  in 
mastering  the  detection  of  abnormal  processes  going  on  within 
the  chest  and  abdomen.  The  present  edition  should  prove  as  pop- 
ular as  its  two  immediate  predecessors.  It  gives  us  much  pleasure 
to  place  our  stamp  of  approval  upon  it  and  to  recommend  it  most 
highly  to  the  kindest  consideration  of  our  readers. 

Physiology  and  Biochemistry  in  Modern  Medicine.  By  J.  J.  R. 
Macleod,  M.  B.,  Professor  of  Physiology  in  the  University 
of  Toronto,  Toronto,  Canada ;  fomierly  Professor  of  Phy- 
siology in  the  Western  Resen'e  University,  Cleveland,  Ohio. 
Assisted  by  Roy  G.  Pearce,  A.  C.  Redfield  and  N".  B.  Taylor. 
Fourth  edition.  With  243  illustrations,  including  9  plates  iu 
colors.  St.  Louis:  C.  V.  Mosby  Company,  1922.  Cloth, 
$11.00  net. 

Just  as  there  are  anatomical  changes  in  disease,  so  are  there 
physiological  perversions,  l^ot  until  recent  years  has  this  aspect 
of  medicine  been  realized,  and  only  within  the  past  decade  has  it 
been  emphasized  at  all.  This  field  of  medicine  offersi  unlimited 
chances  for  investigation  and  interpretation,  and  will  in  days  to 
come  form  a  goodly  portion  of  the  practice  of  medicine.  Mac- 
leod in  the  above  mentioned  book  has  laid  the  groundwork  for  a 
proper  appreciation  of  this  phase  of  medicine.  The  book  is  a  pa- 
thological physiology  so  written  as  to  indicate  the  application  of 
the  methods  of  the  physiological  laboratory  toward  the  interpre- 


156 

tation  of  disease.  It  stands  iu  tlie  middle  ground  between  text- 
books on  pure  physiology  and  those  on  functional  pathology.  It 
is  not  a  substitute  for  either,  but  a  supplement  to  each,  and  as 
such  has  an  immense  field  of  usefulness. 

Lectures  on  Dietetics.  By  Max  Einhom,  M.  D.,  Eineritus  Pro- 
fessor of  Medicine  at  the  jSTew  York  Post  Graduate  School 
and  Hospital ;  Visiting-  Physician  to  the  Lennox  Hill  Hos- 
pital, ISTew  York.  12mo.  of  244  pages.  Philadelphia  and 
London:  W.  B.  Saunders  Company,  1922.     Cloth,  $2.25  net. 

More  and  more  is  the  profession  coming  to  the  point  of  view 
that  diet  has  an  important  place  in  medicine  both  in  the  preser- 
vation of  health  and  in  the  restoral  of  the  diseased  to  a  healthy 
condition.  The  course  of  many  diseases  can  l)e  changed  for  the 
better  by  a  proper  dietary,  and  many  a  normal  individual  has  been 
made  sick  by  the  improper  use  of  food.  Einhom's  clinical  talks 
considers  both  of  these  phases  of  diet  and  should  contribute  ma- 
teriaJl.y  to  a  more  thorough  understanding  of  the  underlying  fac- 
tors governing  a  sensible  dietary.  It  considers  the  principles  of 
diet  and  nutrition;  the  digestibility  of  foods  and  the  diet  in 
health  and  acute  diseases ;  the  diet  in  chronic  diseases ;  the  care 
of  digestion ;  the  care  of  digestion  of  soldiers ;  the  dietetic  treat- 
ment of  chronic  diarrhoeas ;  the  Allen  treatment  of  diabetes  melli- 
tus ;  the  diet  in  operative  cases  and  a  host  of  other  conditions. 
It  is  a  small  monogTaph,  but  full  of  helpful  hints  and  directions 
and  especially  adapted  to  the  needs  of  the  practitioner  seeking 
first-hand  knowledge  concerning  how  to  feed  this  or  that  person 
in  health  and  disease. 

The  Elements  of  Scientific  Psychology.  By  Knight  Dunlap,  Pro- 
fessor of  Experimental  Psychology  in  the  Johns  Hopkins 
University,  Baltimore;  author  of  "Mysticism,  Freudianism 
and  Scientific  Psychology,"  "Personal  Beauty  and  Racial  Bet- 
terment," etc.  Illustrated.  St.  Louis :  C.  Y.  Mosby  Com- 
pany, 1922.     Cloth,  $3.50  net. 

This  book  is  written  with  the  view  to  introducing  the  student  to 
the  elements  of  psychology  and  for  the  pui-pose  of  giving  him  a 
proper  foundation  for  a  genuine  understanding  of  the  more  in- 
tricate problems  of  the  science  of  the  mind.  It  therefore  deals 
with  general  problems  of  pyschology^  only,  leaving  the  special 
topics  to  books  devoted  to  the  more  highly  developed  aspects  of 
the  subject.  It  just  touches  the  high  spots.  ISTot  until  these  are 
thoroughly  mastered  is  the  student  prepared  to  avail  himself  of 
the  more  technical  side  of  the  subject. 


UNIVERSITY  OF  MARYLAND 

BULLETIN 

OF  THE 

SCHOOL  OF  MEDICINE 

Vol.  VII  APRIL,  1923.  No.  4 

SOME  PHASES  OF  DIABETES  MELLITUS 

By  Harry  M.  Stein,  M.  D.,  Baltimore; 

Read  before  the  Clinical  Club  of  Baltimore,  December  9,  1922 

"The  nature  of  the  disease  then  is  chronic  and  it  takes  a  long  pe- 
riod to  form ;  but  the  patient  is  shortlived,  if  the  constitution  of  the 
disease  be  completely  established ;  for  the  melting  is  rapid ;  the  death 
speedy.  Moreover,  life  is  disgusting  and  painful ;  thirst  unquench- 
able; excessive  drinking  which,  however,  is  disproportionate  to  the 
larger  quantity  of  urine,  for  more  urine  is  passed;  and  one  cannot 
stop  them  either  from  drinking  or  making  water.  Or  if  for  a  time 
they  abstain  from  drinking  their  mouths  become  parched  and  their 
bodies  dry ;  the  viscera  seem  as  if  scorched  up ;  they  are  affected 
with  nausea,  restlessness  and  a  burning  thirst ;  and  at  no  distant 
term  they  expire." 

This  was  written  (200  to  300  A.  D.)  by  Aretaeus,  a  Cappadocian. 
Whether  this  is  the  first  clinical  description  of  diabetes  mellitus  or 
not,  it  certainly  is  a  clear  picture  and  serves  to  show  us  that  the  con- 
dition has  been  recognized  for  a  long  time.  That  its  interest  is  in- 
creasing is  best  testified  to  by  the  enormous  literature  which  has 
arisen,  especially  since  1914.  That  its  clinical  recognition  and  study 
are  important  is  shown  by  the  figures  of  Joslin,  which  indicate  a 
mortality  increase  from  this  disease  of  80  per  cent,  between  1900  and 
1915  (in  the  United  States),  whereas  there  was  a  decrease  of  24 
per  cent,  in  deaths  from  all  causes. 

It  has  been  my  good  fortune  to  see  during  the  past  eighteen  (18) 
months  twenty-eight  (28)  cases  of  diabetes,  and  it  is  my  purpose 
tonight,  after  briefly  referring  to  this  group,  to  select  from  it  cases 
illustrative  of  certain  interesting  phases  of  this  condition.  Three  of 
these  patients  were  seen  but  once,  and  these  were  young  men  who 
were  completely  ignorant  of  the  presence  of  any  organic  disease. 
Twenty-five  (25)  patients  I  have  been  able  to  follow  closely  for  vary- 
ing lengths  of  time.  Twenty-two  (32)  patients  were  at  one  time  or 
another  treated  in  the  hospital,  and  these  received  training  along  the 
lines  of  dietetics,  personal  care  and  hygiene,  examinations  of  urine, 
etc.  The  knowledge  acquired  by  some  of  them  is  quite  remarkable 
and  I  cannot  refrain  from  emphasizing  here  the  importance  of  hav- 
ing all  diabetics,  whenever  possible,  educated  in  the  things  needful 
for  their  favorable  progress. 


158 

Ten  (10)  patients  were  male  and  fifteen  (15)  females.  There 
was  one  negro  (female),  six  Hebrews  and  one  child  in  the  series. 
Only  one  patient  had  lues,  as  expressed  by  a  positive  blood  Wasser- 
mann,  and  with  this  one  exception  none  of  them  had  any  clinical 
evidences  of  syphilis  that  could  be  detected.  The  age  of  the  young- 
est patient  was  three  years  and  that  of  the  oldest  sixty-two  (62) 
years.  Thirteen  (13)  were  fifty  (50)  years  of  age  or  more,  and  six 
(6)  cases  were  thirty  (30)  or  under,  the  average  age  incidence  being 
forty-eight  (48)  years.  Of  the  total  number  glycosuria  was  dis- 
covered at  the  time  of  the  first  visit  in  ten  cases. 

There  was  one  case  occurring  with  pregnancy,  this  in  a  Jewess 
twenty-two  years  old,  who,  although  faihng  to  adhere  strictly  to  her 
diet,  went  to  term  and  was  delivered  of  a  healthy  child.  Her  subse- 
quent recovery  was  uneventful.  The  patient  three  years  old  referred 
to  above  has  been  sugar  free  for  one  year,  maintains  a  plasma  sugar 
within  normal  limits  and  is  apparently  doing  well. 

History  of  trauma  preceding  the  diabetes  occurred  in  one  case. 
This  patient  was  a  white  man,  who  was  sixty-one  years  old  when  he 
first  came  under  observation,  glycosuria  having  been  discovered 
seven  months  previously.  As  a  result  of  an  accident  in  1915,  he  suf- 
fered a  depressed  fracture  of  the  skull,  for  which  a  craniotomy  was 
done,  there  being  no  sugar  present  in  the  urine  at  that  time. 

Symptoms  such  as  polydypsia,  polyuria  and  neuritic  pains  in  the 
extremities  did  not  present  themselves  until  six  years  after  injury. 

The  question  of  trauma  preceding  diabetes  has  always  been  the 
subject  of  much  discussion  and  the  existence  of  a  transitory  glyco- 
suria following  trauma  cannot  be  denied,  but  I  do  not  see  how  in 
itself  it  can  produce  a  true  diabetes.  Surely,  when  one  considers  the 
physiology  and  pathology  of  diabetes,  he  must  conceive  that  injury 
as  an  actual  cause  of  the  condition  is  to  say  the  least  very  doubtful. 
It  is  generally  agreed  that  glycosuria  follows  injury  to  the  head  more 
often  than  elsewhere,  and  in  a  series  of  cases  studied  by  Brouardel 
seventeen  out  of  thirty-three  were  of  this  nature.  The  glycosuria 
usually  appears  soon  after  the  injury,  and  if  it  occur  as  long  as  two 
years  or  more  later,  it  can  be  looked  upon  as  having  no  connection. 

Investigation  along  this  line  was  made  by  a  number  of  observers 
during  the  World  War,  inasmuch  as  a  wealth  of  material  was  avail- 
able for  study,  but  no  evidence  of  any  moment  was  obtained  to  sup- 
port the  view  that  trauma  was  in  itself  ever  capable  of  producing 
diabetes. 

On  Overweight  in  Relation  to  Diabetes 

It  is  a  well  established  fact  that  in  the  presence  of  other  wasting 
diseases,  diabetes  is  almost  unknown,  and  the  connection  between 
diabetes  and  obesity  seems  to  be  rather  definitely  established.  Joslin 
once  said  that  diabetes  was  a  penalty  for  obesity,  and  in  a  recent 
article  by  him  he  makes  mention  of  a  very  interesting  bit  of  informa- 
tion gathered  from  insurance  statistics.  It  is  to  the  effect  that  the 
frequency  of  constitutional  diseases  increases  as  age  advances  and 
particularly  as  obesity  advances  but  that  diabetes  is  to  this  extent 
different  inasmuch  as  its  incidence  increases  with  age  only  with  per- 
sons who  are  fat,  while  in  those  who  are  thin  it  remains  constant 


159 

throughout  life.  Again,  Kisch  (A.  M.  A.  Journal,  March,  1915) 
has  called  attention  to  the  frequency  with  which  diabetes  develops 
in  the  later  lives  of  fat  children.  It  has  been  shown  in  insurance 
statistics  that  after  the  age  of  thirty  an  individual  increases  his 
chances  for  life  by  being  moderately  underweight,  and  it  is  well  to 
impress  this  fact  upon  all  patients. 

Romanelli  (Journal  A.  M.  A.,  1915)  reports  rejection  of  308  in- 
surance applicants  because  of  obesity,  and  of  this  number  twenty-one 
per  cent,  had  glycosuria. 

The  condition  of  obesity  is  frequently  associated  with  other  fac- 
tors in  the  problem  of  diabetes.  Thus  we  all  know  how  often 
obesity  is  linked  hand  in  hand  with  over-eating,  inadequate  amount 
of  exercise,  poor  musculature  and  body  frame-work.  It  must  finally 
be  acknowledged  that  overweight  occurs  so  frequently  with  this  con- 
dition that  it  is  impossible  to  disregard  the  relationship  between  the 
two. 

In  only  four  cases  of  this  group  was  there  a  family  history  of  over- 
weight, but  in  sixteen  of  them  there  was  definite  overweight  either 
at  the  time  of  the  first  interview  or  at  some  time  previous.  Several 
of  them  are  worth  mentioning  in  greater  detail. 

Case  No.  5.  Age  31.  Had  been  fat  since  childhood.  Weight  200 
pounds.  Ideal  weight  130  pounds.  She  eats  a  great 
deal,  especially  sweets,  and  has  been  steadily  gaining  weight  for  the 
past  five  years.  There  has  been  abnormal  thirst  and  polyuria  for  one 
year.  She  developed  a  gall  bladder  attack,  and  after  admission  to 
the  hospital  it  was  discovered  that  sugar  was  present  in  the  urine. 
A  drainage  of  the  gall  bladder  was  done  and  she  made  a  good  re- 
covery. 

Case  No.  10.  First  seen  at  the  age  of  44.  Two  years  previously  he 
weighed  265  pounds,  which  was  79  pounds  over  his 
ideal  weight.  Had  lost  50  pounds  four  months  before  admission 
to  the  hospital.  He  had  a  large  appetite,  with  an  unquenchable  thirst, 
and  when  first  seen  had  a  large  sloughing  carbuncle  of  the  neck. 

Case  No.  12.  A  white  man,  age  24,  who  acknowledged  sedentary 
habits,  ate  large  quantities  of  food  with  much  candy. 
He  has  always  been  fat,  but  knows  that  his  weight  is  steadily  increas- 
ing. There  is  a  history  of  repeated  attacks  of  tonsillitis  occurring 
during  the  past  three  years.  Glycosuria  was  discovered  at  the  time 
of  his  first  visit.  His  best  weight,  which  is  his  present  one,  is  320 
pounds.  He  should  weigh  150  pounds.  He  never  feels  well  and 
says  that  he  is  "in  his  own  way."  Was  first  seen  in  February,  1922, 
and  at  the  end  of  eight  months'  treatment  he  had  lost  141.  pounds. 
He  feels  better  now  than  ever  before  in  his  life,  and  when  seen  by 
me  at  a  very  recent  date  it  was  almost  impossible  to  associate  his 
physical  appearance  with  that  of  the  heavy,  cumbersome  man  of  a 
few  months  previous. 

Case  No.  18.     W^eighed  340  pounds  five  years  previous  to  the  time 
diabetes  was  discovered  and  he  was  then  163  pounds 
over  weight.    At  his  first  visit  he  still  weighed  23  pounds  more  than 
he  should. 


160 

These  cases  are  cited  because  they  represent  the  more  unusual 
ones,  but  it  is  to  be  remembered  that  64  per  cent,  of  the  total  number 
were  overweight.  Despite  the  fact  that  this  analysis  is  made  from 
a  small  group  of  cases,  it  certainly  bears  out  the  knowledge  of  the 
definite  relation  between  fat  and  diabetes. 

Relationship  of  Heredity  to  Diabetes 

The  question  of  heredity  is  a  vital  one,  especially  from  the  stand- 
point of  prophylaxis  and  early  diagnosis.  Heredity  is  looked  upon 
by  some  as  being  a  favorable  omen,  but  one  must  not  lose  sight  of  the 
fact  that  the  onset  of  the  disease  is  apt  to  be  earlier  in  successive 
generations  and,  therefore,  of  the  more  severe  type.  Recognizing 
the  fact  that  diabetes  may  be  unfavorably  influenced  by  heredity, 
the  examination  of  blood  relatives  of  known  diabetics  is  to  be  en- 
couraged whenever  possible.  The  investigation  of  the  carbohydrate 
tolerance  of  this  group  of  individuals  has  shown  us  that  it  is  abnor- 
mal in  many  instances,  and  a  latent  diabetes  will  often  be  discovered 
by  this  method,  where  otherwise  it  would  go  on  undetected  for 
an  indefinite  length  of  time.  It  seems  to  me,  therefore,  that  we 
should  make  every  effort  to  have  the  children  of  our  diabetic  patients 
examined  carefully  along  the  lines  mentioned  before.  In  dealing 
with  this  disease  many  of  us  are  acquainted  with  the  frequency  in 
which  a  positive  family  history  is  met  with,  and  although  this  group 
of  patients  is  too  small  to  warrant  the  drawing  of  any  conclusions 
regarding  familial  influence,  there  are  several  cases  which  are  de- 
serving of  mention.  In  four  of  the  total  number  there  was  a  history 
of  diabetes  in  the  families. 

Case  No.  15.     White  female,  age  57.    Her  father  died  of  heart  dis- 
ease at  the  age  of  75,  but  suffered  from  diabetes  for 
several  years  previous  to  his  death. 
Case  No.  17.     White  female,  age  54  years.    Had  a  sister  who  died  in 

diabetic  coma  at  the  age  of  28, 
Case  No.  22.  White  female,  age  57  years.  Father  and  mother  both 
died  of  senility  at  ages  over  75.  She  has  two  sisters 
living  and  well.  One  sister  is  living  and  has  diabetes,  and  there  is 
one  brother  living,  age  51,  who  has  a  mild  diabetes.  This  brother  has 
a  son  with  diabetes.  Her  grandfather  on  her  father's  side  died  of 
diabetes,  as  did  also  her  great-grandfather  on  father's  side. 

Surgery  and  Diabetes 

Under  this  heading  we  must  keep  in  mind  that  certain  complica- 
tions of  diabetes  of  themselves  require  surgical  procedures  and  like- 
wise that  the  diabetic  patient  is  not  exempt  from  any  of  the  many 
surgical  diseases.  It  certainly  follows  then  that  diabetics  need  more 
surgery  than  the  average  individual.  The  mortality  in  the  past 
amongst  this  class  of  patients  has  been  frightfully  high,  most  of  this 
being  due  to  unwise  management.  Barring  cases  of  recognized 
surgical  emergencies,  the  pre-operative  care  as  well  as  the  choice  of 
both  time  and  anesthetic  should  rest  entirely  with  the  internist  or  at 
least  be  subject  to  his  recommendation.  Operations  should  be  de- 
ferred whenever  possible  and  vigorous  treatment  of  the  diabetes 


161 

be  instituted.  The  probable  benefits  to  be  derived  from  this  obvi- 
ously simple  truth  can  be  noted  in  the  tendency  that  many  appar- 
ently serious  surgical  conditions  have  to  clear  up  when  the  diabetes 
is  properly  handled.  We  must  not  lose  sight  of  the  not  infrequent 
occurrence  of  coma  following  operations  upon  untreated  cases.  Thus 
two  cases  in  this  series  were  seen  in  coma  following  operation,  one 
after  the  removal  of  an  ovarian  cyst  and  the  other  after  incision 
and  drainage  of  an  extensive  cellulitis. 

The  success  or  failure  practically  always  depends  upon  preliminary 
treatment.  These  patients  should  be  made  sugar  and  acid  free,  and 
hyperglycemia  reduced ;  regulation  of  the  bowels  must  never  be 
overlooked ;  their  highest  tolerance  should  be  attained  and  for 
twenty-four  hours  preceding  operation  they  should  be  given  gener- 
ous quantities  of  fluids.  All  of  these  things  are  extremely  impor- 
tant, and  especially  so  for  those  patients  who  are  to  receive  a  general 
anesthetic.  If  this  plan  be  faithfully  followed  these  people  invaria- 
bly do  well  and,  except  in  instances  where  some  unforeseen  accident 
occurs,  a  favorable  outcome  can  be  expected.  It  would  seem  almost 
unnecessary  to  mention  the  above  facts,  but  it  is  really  surprising 
how  many  times  their  importance  is  overlooked.  The  consideration 
of  the  type  of  anesthetic  depends  largely  on  the  nature  of  the  sur- 
gical condition.  Whenever  possible  local  anesthetics  should  be  used, 
and  spinal  anesthesia  has  often  been  employed  with  reports  of  excel- 
lent results.  Next  of  choice  is  nitrous  oxide  and  oxygen  and  the 
last  is  ether,  or  better  still  a  combination  of  gas,  oxygen  and  ether. 
Chloroform  should  be  used  under  no  circumstance.  If  taking  a 
general  anesthetic,  the  patient  should  be  anesthetized  before  going 
to  the  operating  pavillion,  in  order  to  avoid  needless  apprehension 
and  excitement.  The  period  of  anesthesia  should  always  be  as  short 
as  possible  and  careful,  gentle  handling  of  the  tissues  is  highly  de- 
sirable. 

From  time  to  time  one  sees  patients  who  are  given  general  anes- 
thetics in  the  presence  of  glycosuria  and  who  apparently  do  well. 
This  may  be  because  of  the  fact  that  the  diabetes  is  a  mild  one,  or 
because  of  the  pre-operative  withholding  of  food  in  the  presence  of 
pain  and  vomiting,  which  latter  procedure  is  really  a  beneficial  one 
from  the  standpoint  of  the  diabetes. 

Twelve  of  my  patients  had  conditions  requiring  surgical  inter- 
ference either  of  a  major  or  minor  nature.  As  mentioned  before, 
two  of  these  were  seen  after  operation  and  in  coma.  Seven  of  the 
others  were  given  general  anesthetics  and  of  these  five  were  known 
to  have  glycosuria,  sugar  being  discovered  in  the  urine  of  the  other 
two  after  operation.  In  four  patients  there  was  a  history  of  gall- 
bladder disease  preceding  the  discovery  of  the  diabetes,  and  in  two 
of  them  definite  pancreatitis  was  demonstrated  at  the  time  of  oper- 
ation. 

The  following  is  a  table  showing  the  existing  surgical  conditions : 

( 1 )  Complete  prolapsus  uteri  with  urgent  and  distressing  pressure 
symptoms. 

(2)  Acute  cholecystitis. 

(3)  Glaucoma. 


162 

(4)  (2  cases)  Hypertrophied  tonsils  with  history  of  recurrent  at- 
tacks of  tonsillitis. 

(5)  Ovarian  cyst. 

(6)  (2  cases)  Carbuncle  of  the  neck. 

(7)  Chronic  osteomyelitis  of  bones  of  foot. 

(8)  Acute  cholecystitis  with  pancreatitis. 

(9)  Cellulitis  of  foot  and  leg. 
(10)   Diabetic  ulcer  of  the  toe. 

Only  four  of  these  conditions  could  be  considered  as  definite  dia- 
betic complications,  the  remainder  occurring  as  incidental  surgical 
diseases.    Several  cases  are  of  some  interest. 

Case  No.  3.  White  female,  age  57.  Duration  of  diabetes  IV2  years. 
Presented  herself  with  complete  prolapse  of  the  uterus, 
(urgent  pressure  symptoms  from  this),  polyuria  and  pruritus 
vulvae.  Treatment  for  the  diabetes  had  always  been  indifferent,  and 
on  admission  to  the  hospital  there  was  6.4%  glucose  in  the  urine, 
with  diacetic  acid  and  acetone  present.  She  responded  well  to  three 
weeks  of  preliminary  treatment,  was  operated  upon  under  general 
anesthesia  followed  by  an  uneventful  recovery. 

Cask  No.  12.  A  white  male,  age  24.  Was  170  pounds  overweight. 
History  of  recurrent  attacks  of  tonsillitis.  One-half 
of  1%  glucose  was  present  in  the  urine,  but  inconstantly  so.  Typical 
diabetic  sugar  curve.  After  preliminary  treatment,  the  tonsils  were 
removed  under  general  anesthesia  followed  by  an  uneventful  re- 
covery.   Patient  still  sugar  free  ten  months  later. 

Case  No.  9.  White  male,  age  60.  Without  previous  history  of 
diabetes  (?),  20  pounds  overweight.  Had  an  acute 
gall-bladder  attack  accompanied  by  vomiting  and  restriction  of  food 
for  several  days  previous  to  admission  to  hospital.  The  first  ex- 
amination of  the  urine  showed  it  to  be  sugar  free  and  the  plasma 
sugar  was  124  mgms.  per  1,00  cc.  A  few  days  after  operation  1% 
of  sugar  was  discovered  in  the  urine,  and  the  plasma  sugar  at  this 
time  was  180  mgms.  per  100  cc.  Glycosuria  was  constantly  present 
until  controlled  by  a  regulation  of  the  diet.  A  number  of  specimens 
subsequently  examined,  after  the  patient  had  made  a  good  recovery 
and  was  discharged  from  the  hospital,  were  sugar  free.  His  diet, 
although  liberal,  is  restricted.  It  is  interesting  to  speculate  here, 
first,  as  to  whether  he  had  a  mild  diabetes  in  which  hyperglycemia 
and  glycosuria  were  reduced  under  the  necessary  restriction  of  diet, 
or  secondly,  whether  he  had  a  transitory  glycosuria  associated  with 
acute  disturbance  of  pancreatic  function. 

As  far  as  the  post-operative  care  is  concerned  there  are  two  phases 
worthy  of  notice.  The  first  is  that  these  patients  should  be  quickly 
returned  to  their  maximal  diet,  and  the  second  that  wherever  possible 
hypodermic  injections  and  sub-pectoral  salt  administrations  should 
be  avoided  because  of  the  apparent  vulnerability  of  their  tissues  and 
their  proneness  to  local  infections. 


163 

Mortality 

Five  of  these  patients  died,  all  in  coma.  Two  of  them  have  been 
referred  to  previously,  and  two  others  refused  to  follow  treatment. 
The  last  to  be  mentioned  was  a  white  female  who  had  a  diabetes  of 
two  months'  duration  when  first  seen,  and  despite  a  long  course  in 
the  hospital,  diligent  and  honest  co-operation,  she  grew  rapidly 
worse  despite  any  dietetic  arrangement  that  was  tried.  Death  came 
four  months  after  the  beginning  of  treatment. 

In  two  patients  the  presence  of  the  soft  eyeball  was  noted,  this 
sign  being  rather  significant,  as  it  is  supposed  to  occur  only  in  coma 
of  diabetic  origin. 

This  paper  has  of  necessity  been  fragmentary,  but  I  cannot  con- 
clude without  making  a  brief  allusion  to  the  most  interesting  of  all 
diabetic  complications,  namely :  Coma.  It  is  a  matter  of  great  sur- 
prise that  such  a  dramatic  and  common  termination  of  diabetes  re- 
ceived little  or  no  notice  until  its  recognition  and  description  by 
Kussmaul  in  1874.  For  example,  Trousseau,  the  brilliant  French 
clinician  of  the  time  just  preceding  this  date,  while  recognizing  such 
complications  as  gangrene  of  the  extremities,  and  even  of  the  lungs, 
states  that  as  a  general  rule  "Diabetic  patients  sink  slowly,  succumb- 
ing under  the  complication  of  tubercular  pulmonary  phthisis." 


ECTOPIC  PREGNANCY 

Causes  and  Diagnosis,  with  Report  of  85  Cases 

By  C.  Frud  Fisher,  M.  D. 
Resident  Gynecologist,  University  Hospital,  Baltimore 

By  ectopic  pregnancy  is  meant  the  development  of  the  fertilized 
ovum  outside  the  uterine  cavity,  in  the  horn  of  the  uterus,  in  the 
fallopian  tube  or  in  the  free  abdominal  cavity. 

There  are  various  causes  given  for  this  very  interesting  condition. 
F.  P.  Mall  states  after  an  examination  of  many  specimens  that  this 
condition  is  associated  quite  definitely  with  inflammatory  changes 
that  must  have  preceded  the  lodgment  of  the  ovum  in  the  fallopian 
tube,  and  the  causative  organism  in  nearly  all  the  cases  is  the  gono- 
coccus.  This  organism  invades  the  tube,  causing  an  inflammatory 
reaction,  which  in  the  course  of  repair  causes  adhesions  of  the  fimbria 
in  the  tube,  forming  "false  channels,"  into  which  the  impregnated 
ovum  falls  and  develops. 

The  normal  tube  is  lined  with  ciliated  epithelium  which  assists  the 
ovum  in  its  descent  toward  the  uterine  cavity  and  anything  that  de- 
lays the  ovum  in  its  course  may  be  the  cause  of  this  condition.  It 
has  been  stated  that  the  infantile  type  of  tube  may  be  the  cause 
where  there  have  been  no  inflammatory  changes,  the  many  convolu- 
tions in  the  tube  impeding  the  course  of  the  ovum. 

Sippel  bases  his  theory  on  the  transmigration  of  the  ovum,  where 
at  operation  the  corpus  luteum  verum  has  been  found  in  the  opposite 
ovary,  from  the  tube  in  which  the  pregnancy  occurred ;  the  ovum  in 


164 

its  journey  across  the  distance  between  that  ovary  and  the  tube  in- 
volved has  increased  in  size  so  much  that  it  will  not  pass  the  uterine 
end  of  the  tube,  but  it  can  also  be  assumed  that  the  changes  in  the 
egg  that  represent  the  first  changes  toward  nidation,  due  to  the  long 
journey  of  the  ovum,  might  take  place  in  the  tube  instead  of  in  the 
uterus  as  they  normally  do. 

Katz  explains  the  cause  in  normal  tubes  as  an  aberration  of  some 
normal  physiologic  function  of  the  corpus  luteum.  The  normal  func- 
tion given  by  him  of  the  corpus  luteum  is  to  cause  in  the  tubes  both 
at  the  time  of  pregnancy  and  menstruation  an  enormous  increase  in 
the  cells  that  line  the  tube,  and  causes  such  a  piling  up  of  cells  that 
the  lumen  of  the  tube  is  obstructed  when  the  corpus  luteum  is  abnor- 
mally stimulated. 

The  theory  supported  by  Mall  is  the  one  most  generally  accepted 
today.  Extrauterine  pregnancy  as  a  rule  occurs  in  women  who  have 
had  a  period  of  relative  sterility  lasting  several  years,  during  which 
the  tube  by  slow  processes  of  repair  has  attempted  to  return  as  near 
to  normal  as  possible,  but  the  ovum  descends  in  the  "false  channel 
formation  period"  before  a  continuous  lumen  might  have  established 
itself,  which  if  it  had  been  allowed  to  return  more  nearly  to  normal 
the  ovum  might  have  had  free  passage  and  a  normal  uterine  preg- 
nancy resulted.  This  might  be  made  more  clear  by  naming  those 
cases  in  which  a  normal  uterine  pregnancy  had  occurred  after  one 
ectopic  pregnancy  and  at  operation  only  the  affected  tube  was  re- 
moved, the  remaining  tube  having  had  a  chance  to  establish  a  perfect 
lumen  again. 

It  has  also  been  stated  that  the  development  of  an  ovum  in  a  tube 
showing  chronic  inflammatory  changes  will  usually  be  successful, 
but  if  the  infection  be  active  or  recent  the  ovum  will  rapidly  die  and 
disintegrate.  But  this  last  statement  does  not  hold  true  in  a  recent 
case  in  this  hospital  where  at  operation  a  pus  tube  was  found  on  one 
side  and  on  the  other  an  unruptured  ectopic  pregnancy  containing 
a  two  months'  foetus. 

Von  Winkel  states  that  of  all  those  that  survive  and  develop  only 
one-fifth  remain  normal,  the  remainder  becoming  monsters  or  are 
pathological. 

Those  that  rupture  into  the  abdominal  cavity  except  in  rare  in- 
stances die.  The  rupture  of  the  tube  and  deposit  of  the  product  of 
conception  into  the  broad  ligament  favors  further  development. 

It  takes  about  six  weeks  for  an  ovum  to  increase  in  size  sufficient 
to  cause  recognizable  symptoms,  and  relatively  common  are  those 
cases  who,  believing  themselves  to  have  a  normal  uterine  pregnancy, 
and  attempting  to  abort  themselves,  come  into  the  hospital  for  the 
relief  of  the  continued  and  prolonged  bleeding,  or  alarming  symp- 
toms of  infection,  or  from  the  cramp-like  pelvic  pains  after  they 
have  passed  what  they  have  thought  to  be  the  normal  secundines, 
but  which  was  really  a  cast  of  the  decidua,  and  when  examined  were 
found  to  have  an  ectopic  pregnancy. 

Werth  states  that  probably  only  one  per  cent,  reach  maturity  and 
most  die  in  the  first  month.  He  also  states  that  this  condition  is  rare 
in  rural  communities,  and  most  common  in  the  cities,  and  runs  par- 
allel with  the  venereal  statistics. 


165 

If  the  symptoms  of  a  normal  pregnancy  do  not  bring  the  patient 
to  a  doctor  this  condition  is  usually  not  recognized  until  rupture  o' 
some  other  accident  occurs. 

The  cause  of  tubal  rupture  in  this  condition  has  been  explained 
in  many  ways,  but  has  been  stated  by  W.  S.  Gardner  to  be  due 
to  the  stretching  of  the  tube  beyond  its  normal  limit  of  elasticity, 
plus  the  weakening  of  the  wall  by  the  corrosive  action  of  the  chori- 
onic villi.  Acute  tubal  rupture  might  be  due  to  the  sudden  hem- 
orrhage in  the  tube  due  to  the  rupture  of  one  of  the  vessels  in  the 
tube  wall,  the  tube  being  stretched  beyond  its  elasticity  by  the  grad- 
ually increasing  hemorrhage. 

Shortly  after  rupture  takes  place  uterine  bleeding  nearly  always 
follows  and  not  a  hemorrhage  from  the  tube,  as  is  often  thought. 
Sampson  has  shown  by  the  injection  of  uteri  that  the  bleeding  is 
venous.  This  bleeding  continues  or  a  bloody  sanguinous  discharge 
takes  its  place  until  the  afifected  tube  is  removed. 

The  uterine  decidua  may  come  away  as  a  triangular  cast  or  be  cast 
out  in  shreds. 

The  accidents  that  may  befall  a  tubal  pregnancy  may  be  stated  as 
follows : 

Tubal  rupture — rupture  of  the  tube  wall  with  or  without  rupture 
of  the  amniotic  sac. 

Tubal  abortion — rupture  of  the  amniotic  sac  and  not  the  tube  wall. 

The  latter  may  or  may  not  be  serious  as  regards  life  and  death,  for 
the  accident  may  not  be  associated  with  hemorrhage  of  any  great 
moment ;  on  the  other  hand  there  may  be  a  slow  and  steady  flow  of 
blood  from  the  fimbriated  end  of  the  tube.  The  former  may  give 
rise  to  very  urgent  symptoms  and  a  tragic  result  if  not  given  imme- 
diate treatment.    Fatal  cases  are  usually  of  this  type. 

The  diagnosis  is  made  at  times  before  any  accidents  occur.  A 
patient  who  may  or  may  not  have  had  a  period  of  relative  sterility 
seeks  medical  advice  for  what  she  thinks  is  a  normal  uterine  preg- 
nancy, and  in  the  course  of  the  routine  pelvic  examination  is  found 
to  have  a  tender  mass  in  one  or  the  other  of  the  adnexa  regions,  and 
perhaps  a  slight  uterine  enlargement,  but  uterine  enlargement  men- 
tioned by  many  is  not  a  constant  clinical  fact.  If  she  give  a  history 
of  pelvic  inflammatory  disease  the  diagnosis  is  difficult,  but  if  it  be 
doubtful,  it  is  better  to  err  on  the  safe  side  and  institute  proper  sur- 
gical intervention,  rather  than  let  the  patient  go  on  with  a  doubt 
whether  the  condition  be  a  pus  tube  or  an  ectopic  pregnancy,  sub- 
jecting her  to  a  chance  of  an  abdominal  catastrophe.  If  it  is  an 
ectopic  you  have  done  the  patient  a  great  service  and  if  it  be  a  pus 
tube  it  may  be  removed  with  relative  safety  to  the  uterine  pregnancy 
if  one  be  present.  A  patient  was  sent  to  this  hospital  not  long  ago 
with  what  was  thought  to  be  acute  salpingitis,  but  her  menstrual 
period  had  gone  over  one  week  in  time,  after  citing  a  normal  men- 
strual history,  the  period  to  come  on  with  pain  in  the  lower  abdo- 
men, and  bleeding  from  the  vagina  that  continued  long  after  her 
period  should  have  ceased,  with  slight  enlargement  of  the  uterus,  and 
a  tender  mass  in  the  adnexa  region.  She  was  operated  and  a  pus 
tube  found  on  one  side,  and  a  large  unruptured  ectopic  on  the  other. 


I  166 

The  most  typical  and  often  the  most  tragic  are  the  cases  seen  just 
after  rupture  has  taken  place. 

The  history  in  most  cases  is  as  follows :  That  a  woman  in  good 
health  passes  her  normal  menstrual  time  without  flow,  paying  more 
or  less  attention  to  it,  believing  herself  to  be  normally  pregnant,  is 
taken  suddenly  with  severe  pain  in  either  side  of  the  abdomen  and 
may  faint.  The  pain  remains  in  the  pelvis  and  continues  as  a  colicy 
discomfort,  with  tenderness  in  the  same  region.  Soon  after  bleeding 
from  the  vagina  begins.  The  bleeding  is  in  small  amount  but  per- 
sistent. 

The  fact  that  the  bleeding  is  constant  and  pain  severe  brings  the 
woman  to  her  doctor  for  the  relief  of  the  symptoms  of  what  she 
might  term  an  abortion  or  a  menstrual  disturbance,  with  the  ensuing 
diagnosis  from  pelvic  examination.  If  the  patient  survive  the  shock 
and  the  hemorrhage  be  confined  to  the  tube  they  usually  still  com- 
plain of  occasional  pains,  with  tenderness,  in  the  same  region.  Some 
may  pass  a  cast  of  the  decidua  and  think  that  they  have  had  a  com- 
plete uterine  abortion,  and  are  often  curetted  for  relief  from  the 
bleeding  or  the  sanguinous  discharge.  If  the  hemorrhage  ceases  and 
the  pain  subsides,  more  or  less,  patient  may  be  seen  later,  with  a 
hematocele,  often  which  becomes  infected,  with  the  formation  of  a 
pelvic  abscess,  or  with  intoxication  from  absorption  of  the  blood  clot, 
which  is  usually  associated  with  leukocytosis. 

If  the  tube  rupture  into  the  broad  ligament,  without  much  hem- 
orrhage, the  same  picture  occurs  as  with  tubal  abortion  under  the 
same  conditions.  The  appearance  of  all  these  patients  is  much  alike 
except  those  cases  associated  with  abdominal  hemorrhage  of  any 
marked  degree,  and  in  the  latter  the  picture  is  striking,  presenting 
all  the  classical  symptoms  of  sudden  abdominal  bleeding. 

Except  in  these  latter  cases  where  there  is  any  doubt,  examination 
should  always  be  made  under  anesthesia. 

Hugh  Brent  has  formulated  a  symptom-complex  that  answers  the 
requirements  of  the  individual  gynecologist  or  surgeon,  in  relation 
to  the  question  of  diagnosis  of  this  condition,  upon  which  he  states 
the  diagnosis  may  be  made  without  reservation — that  is,  as  follows : 
Menstruation  missed  or  scant ;  reappearance  of  the  menstrual  flow 
after  an  interval  of  eight  weeks  or  less,  and  its  persistence  as  an 
irregular  sanguinous  discharge.  The  supposition  on  the  part  of  the 
patient  that  an  abortion  is  in  progress.  Passage  of  decidual  cast  or 
shreds.  A  moderate  fall  in  the  hemaglobin  index.  Paroxysmal 
colicy  pains  in  the  right  or  left  of  the  pelvis.  Soft,  tender  extra- 
uterine mass.  Tympanites  and  general  tenderness  over  the  lower 
abdomen. 

The  diagnosis  rests  on  the  taking  of  a  careful  history,  and  a  thor- 
ough pelvic  examination,  under  anesthesia  if  necessary. 

The  time  to  operate  is  when  the  diagnosis  has  been  made,  and  the 
type  of  surgical  procedure  to  adopt  should  be  based  on  the  same 
judgment  as  that  in  treating  a  case  of  pelvic  inflammatory  disease, 
per  se,  conservatism  being  practiced  at  all  times,  remembering  that 
according  to  Richard  R.  Smith  33  per  cent,  have  normal  uterine 
pregnancies  later,  and  only  15  per  cent,  have  a  second  ectopic  preg- 
nancy. 


i 


167 

Below  is  a  summarized  report  gleaned  from  a  study  of  85  con- 
secutive cases  observed  in  the  clinic  of  the  University  Hospital : 

In  25  cases  history  of  venereal  infection  was  positive. 

In  26  cases  history  of  venereal  infection  was  suggestive. 

In  34  cases  history  of  venereal  infection  was  negative. 

In  48  cases  menstrual  history  was  typical. 

In  23  cases  menstrual  history  was  atypical. 

In  14  cases  menstrual  history  was  normal. 

In  33  cases  pain  with  fainting  was  present. 

In  64  cases  the  left  tube  was  the  one  affected. 

In  21  cases  the  tube  was  ruptured  at  the  time  of  operation. 

In     2  cases  the  death  was  due  to  hemorrhage. 

In     1  case    was  the  pregnancy  in  the  tubes  bilateral. 

In     1  case    were  multiple  pregnancies  found  in  one  tube. 

In  52  cases  was  the  pelvic  examination  typical 

In  two  cases  the  patients  thought  themselves  to  be  pregnant  and 
had  attempted  abortion. 

In  one  case  was  the  extrauterine  pregnancy  interstitial  in  type. 

In  three  cases  were  the  pregnancies  abdominal  in  type,  and  two 
of  these  at  full  term. 

In  65  cases  the  patients  were  white. 

In     8  cases  the  uterus  was  enlarged. 

In     2  cases  tubal  abortion  was  complete. 

In     3  cases  there  was  a  recurrent  ectopic  on  the  other  side. 

In  2  cases  patients  returned  here  with  normal  uterine  preg- 
nancies. 

In  4  cases  transfusion  was  required. 

In  one  case  uterine  and  ectopic  pregnancy  were  present  at  the 
same  time. 

In  none  of  the  cases  was  Cullen's  sign  present  (Jour.  A.  M.  A. 
4-4-22.    Novak). 

In  11  cases  was  there  a  history  of  relative  sterility  extending  over 
a  period  of  several  years. 

In  the  report  it  will  be  noticed  that  the  occurrence  of  ectopic  preg- 
nancy is  more  common  in  the  left  than  in  the  right  tube  and  can  pos- 
sibly be  explained  in  the  following  manner,  from  an  anatomical 
standpoint : 

Venous  drainage  from  the  tubes  is  by  the  way  of  the  right  and  left 
ovarian  veins. 

The  left  ovarian  vein  passes  behind  the  sigmoid  flexure  of  the 
colon,  ascends  vertically  upwards  and  enters  the  left  renal  vein  at  a 
right  angle  and  as  a  rule  contains  no  valves. 

The  right  ovarian  vein  ascends  vertically  also,  and  according  to 
Gray  contains  at  least  one  valve  always,  and  empties  into  the  in- 
ferior vena  cava  at  an  acute  angle. 

It  can  be  said  that  early  recovery  from  inflammatory  processes 
depends  largely  on  good  blood  supply  and  drainage  of  the  part  af- 
fected. 

Anatomically  and  theoretically  the  blood  supply  is  not  as  good  in 
the  left  as  it  is  in  the  right  tube,  for  the  left  vein  has  an  irregular 
course,  usually  has  no  valves  to  support  the  column  of  blood  and 


168 

vorks  at  another  disadvantage  because  of  back  pressure  from  the 

nal  vein,  which  it  enters  at  a  right  angle,  and  is  therefore  longer  in 
recovering  from  the  inflammation  and  returning  to  normal  as  a  pre- 
existing infection  of  the  tubal  mucosa  almost  always  has  been  pres- 
ent. 

The  impregnated  ovum  falls  into  the  tube  at  an  unfortunate  time, 
tefore  it  has  had  a  chance  to  return  to  normal,  and  develops  or  not 
ap  the  case  may  be  into  a  tubal  pregnancy,  but  had  the  ovum  fallen 
into  the  right  tube  it  might  have  had  free  and  unobstructed  passage 
through  the  tube  and  entered  the  uterine  cavity,  and  a  normal  uterine 
pregnancy  resulted,  for  at  that  time  the  right  tube  by  its  quick  re- 
cpvery  might  have  established  patency. 

This  fact  has  been  noticed  here  repeatedly  in  the  gynecological 
dlinic  for  pyosalpinx  is  by  far  more  common  in  the  left  tube. 

The  conclusions  that  might  be  drawn  from  the  case  reports  are 
that  in  a  series  of  85  cases : 

The  greatest  number  of  pregnancies  were  in  the  left  tube. 

It  is  more  common  in  white  women,  pyosalpingitis  being  the  result 
usually  in  the  colored  women. 

Ectopic  pregnancy  is  a  fairly  common  condition. 

Emphasizes  the  taking  of  a  careful  menstrual  history  in  all  women 
with  pain  in  the  pelvis. 

Examination  under  anesthesia  in  all  doubtful  cases. 

Cases  with  fatal  hemorrhage  are  rare. 

To  repeat  an  accepted  fact  of  the  close  association  of  pelvic  in- 
flammatory conditions  and  ectopic  pregnancy. 

The  time  to  operate  is  when  the  diagnosis  is  made. 

REFERENCES: 

Graves   Gynecology  2nd   Edition. 

F.  P.  Mall— Surg.,  Gyn.  and  Obstet     Sept.  1915.  page  289  to  298. 

Emil  Novak — Jour.   Amer.   Med.  Ass.   4-4-22. 

W.   S.   Gardner  Textbook   Gynecology. 

Henry  Gray — Anatomy,   1913   Edition.     Page  750. 

Brent — Ectopic  Pregnancy  and  Transfusion.  University  Maryland  Bulletin,  March 
1917,  page  206. 

Brent — Sympton  Complex  of  Extrauterine  Pregnancy.  University  Maryland  Bulletin, 
October   1917,   page   123. 


DIVERTICULA  OF  THE  ESOPHAGUS 

*J.  Harr>-  Ullrich,  M.  D. 

From  tJie  C astro-enterological  Service,  Department  of  Medicine, 

University  of  Maryland 

In  presenting  this  subject  for  your  consideration  it  is  essential  that 
a  sharp  line  of  differentiation  be  drawn  between  esophageal  dilata- 
tion and  diverticulation.  In  the  former  the  entire  circumference  of 
the  tube  is  involved,  while  in  the  latter  only  a  limited  portion  of  the 
esophagus  is  affected,  presenting  a  sac  or  hernia. 

The  types  vary  according  to  the  manner  of  the  development,  and 
may  be  classified  as  traction,  pulsion,  and  traction  pulsion. 

The  location  also  varies.  It  may  occur  in  the  pharnyx,  as  well  as 
any  place  in  the  gullet. 


*   Read  before  the  Gastro-enterological  Society  of  the  University  of  Maryland,  Nov.,  1922. 


169 

Pressure  or  Pulsion  diverticula:  The  literature  on  the  subject 
records  this  type  as  rare,  but  of  greater  clinical  interest.  Sippy  has 
classified  the  locations  as 

( 1 )  In  the  pharynx. 

(2)  At  the  junction  of  the  pharynx  and  esophagus. 

(3)  Near  the  bifurcation  of  the  trachea,  usually  just  above  the 
left  bronchus. 

(4)  Below  the  level  of  the  left  bronchus. 

Number  two  is  the  most  vulnerable  site,  consequently  is  the  most 
common  location  of  the  pulsion  or  pressure  type. 

They  develop  in  pear  shape  sacs  and  increase  in  size  and  capacity, 
varying  from  a  few  c.  c.  to  250  c.  c.  or  more,  until  their  base  may 
rest  upon  the  diaphragm. 

Pathology:  The  pouch-like  sacculation  deformity  may  be  com- 
posed of  one  or  all  of  the  structures  of  the  esophagus.  Usually  it 
consists  of  connective  tissue  and  mucous  membrane ;  the  latter  is 
but  slightly  altered,  while  the  muscular  layer  may  be  atrophied  or 
pushed  aside.  As  the  pouch  develops,  the  esophagus  is  more  or  less 
obstructed  and  impaired  by  pressure. 

Deep  erosions  or  ulcerations  are  rare ;  but  as  the  esophagus  ranks 
about  fifth  in  frequency  among  the  organs,  that  becomes  the  seat  of 
carcinoma ;  this  condition  should  not  be  overlooked  as  a  favorable 
site,  by  reason  of  constant  local  irritation. 

Etiology 

(1)  Congenital  defects. 

(2)  Loss  of  tonicity  in  a  circumscribed  area  resulting  from  dis- 
ease ;  the  lodgment  of  a  large  bolus  of  food  or  a  foreign  body, 
with  continued  indiscreet  diet. 

(3)  Pressure  of  the  left  bronchus  against  the  esophagus  may 
cause  food  to  lodge  on  the  wall  of  the  esophagus,  just  above 
the  bronchus,  and  produce  tissue  weakness  and  eventually 
sacculation. 

(4)  Diverticula  developing  in  the  lower  part  of  the  esophagus  are 
usually  located  anteriorly  or  laterally ;  the  etiology  is  obscure, 

(5)  Age — usually  past  50  years. 

Traction  diverticula  are  the  most  common.  The  local  weakening 
with  corresponding  bulging  is  nearly  always  due  to  contraction  of 
scar  tissue,  attached  to  the  outer  surface  of  the  esophagus.  The 
cicatrix  may  follow  inflammation  of  broncho-lymph-glands  in  the 
area  of  the  bifurcation  of  the  trachea  of  tubercular  subjects. 

Traction  pulsion  diverticulum  may  develop  when  the  opening  of 
the  sac  favors  entrance  and  accumulation  of  food.  This  type  may 
become  large  and  necessarily  serious. 

Symptoms :  Patients  complain  that  food  seems  to  lodge  some- 
where in  the  gullet ;  that  it  is  growing  progressively  worse ;  that 
liquids  are  more  easily  swallowed ;  that  food  is  easily  regurgitated ; 
that  they  cannot  lie  flat  or  with  head  low  without  liquids  welling  up 
in  the  ftiouth,  even  to  the  point  of  almost  strangulation ;  loss  of 
weight ;  weakness ;  no  pain,  but  at  times  considerable  discomfort  or 
sternal  distress  according  to  the  location  and  size  of  the  diverticula. 


I  170 

I])iagnosis :  If  large,  may  be  palpated  and  percussed,  with  change 
of  bosition  of  patient,  enlarged  after  meals ;  welling  up  of  food  and 
liquids ;  plus  the  inability  to  pass  the  stomach  tube  or  bougie  without 
the  aid  of  string  guide.  X-ray  is  the  most  useful  and  dependable. 
The  esophagoscope  should  be  used  last,  bearing  in  mind  always  the 
daager  of  rupture  of  a  possible  aneurism. 

tleport  of  case:  Mr.  B.,  aged  55  years;  chief  complaint,  that 
solid  foods  were  swallowed  with  difficulty. 

During  physical  examination,  in  prone  position,  small  amount  of 
fliid  regurgitated  into  the  mouth,  subsequently  swallowed,  only  to 
be  repeated,  without  relief. 

Stomach  tube  could  not  be  passed  beyond  the  junction  of  the 
pharynx  and  esophagus.  Referred  to  X-ray  department,  with  the 
opinion :  Esophageal  obstruction.  The  case  passed  the  fluoroscopic 
examination  without  detection ;  subsequent  attempt  to  pass  tube 
again  failed ;  Rontgenologist  accordingly  advised  with  the  result  that 
a  second  fluoroscopic  examination  revealed  a  small  pharyngo-eso- 
phageal  diverticulum. 

This  particular  case  is  reported  for  no  other  purpose  than  to  show 
the  importance  of  the  stomach  tube  as  a  sound  in  the  esophagus. 

In  the  differential  diagnosis  the  following  conditions  should  be 
considered :  Dilatation  of  the  esophagus,  aneurism,  parenchymatous 
goiter. 

Prognosis :    Depends  upon  location  and  the  etiological  factors. 

The  pharyngeal  and  pharyngo-esophageal  diverticula  may  be  re- 
lieved or  removed  surgically  in  properly  selected  cases. 

Diverticula  having  their  origin  below  the  sternum  are  considered 
inoperable.  Ruptures  may  take  place  into  the  surrounding  organs  as 
trachea,  bronchi,  pleura  and  blood  vessels  with  disastrous  results. 

Treatment:  Surgical  in  selected  cases.  If  condition  develops  late 
in  life  and  evidences  little  or  no  hindrance  to  passage  of  food,  the 
patient  should  be  directed  to  eat  slowly  and  avoid  coarse  foods.  Ap- 
pearing late  in  life,  though  impossible  to  pass  tube,  serious  symptoms 
may  never  develop.  If  food  stagnates  and  contains  lactic  acid  or 
large  number  of  leucocytes,  irrigate ;  otherwise  do  not. 

Many  different  positions  should  be  tried  most  patiently,  until  one 
most  suitable  to  swallowing  is  found.  In  some  cases  swallowing  is 
best  accomplished  when  the  stomach  is  higher  than  the  mouth.  Tube 
can  always  be  passed  with  safety  by  using  string  guide. 


171 

AN    ANALYTICAL    STUDY    OF    EXTRACRANIAL    A] 

EURISM   OF  THE  INTERNAL  CAROTID 

ARTERY  OF  EROSIVE  ORIGIN 

By  Nathan  Winslow 

(From  the  Surgical  Department  of  the   University  of  Maryland y 

In  this,  the  third  instalment  *  of  my  serial  on  extracranial  aneu- 
rism of  the  internal  carotid  artery,  I  have  attempted  to  collect  all 
of  the  cases  of  this  lesion,  reported  in  the  literature  as  erosive. 
Naturally,  some  have  been  missed  despite  every  effort  to  make  the 
list  complete.  All  told,  I  could  discover  the  case-reports  of  only  18 
examples  of  this  aneurism  published  in  the  domestic  and  foreign 
literatures.  The  smallness  of  the  number  is  undoubtedly  due  to  the 
hesitancy  of  physicians  to  report  their  failures,  notwithstanding 
equally  as  important  lessons  are  to  be  learnt  from  mistakes  as  from 
successes.  Of  all  the  varieties  of  carotid  aneurism,  this  is  by  far 
the  most  weird,  the  most  confusing,  the  most  treacherous.  As  the 
series,  as  a  whole,  is  such  a  pathetic  exhibition  of  colossal  blunders 
"  in  diagnosis  and  in  treatment,  I  have  made  rather  full  abstracts  of 
the  cases.  For  the  convenience  of  the  reader,  I  have  incorporated 
these  in  two  tables:  (1)  those  subjected  to  some  form  of  radical 
arterial  surgery;  (2)  those  tha.t  were  not. 

The  cases  number  18,  of  which  12  died  and  6  recovered ;  12  were 
males,  5  were  females  and  the  sex  of  one  was  not  stated.  The  ages 
were  11  months,  2Vz,  4,  6,  8,  9,  13,  16,  18,  19,  20,  20,  39,  48,  56,  58 
and  60  years  respectively.  In  one  instance  the  age  was  not  recorded. 
The  left  side  was  affected  12  times ;  the  right  6.  Radical  operation 
was  done  9  times.  Of  these  patients,  5,  or  55.5%,  recovered  and 
4,  or  44.5%,  died.  The  deaths  were  attributed  to  hemorrhage,  2 
times ;  sepsis,  exhaustion  and  hemorrhage,  once ;  pneumonia,  once. 
Of  the  9  cases  not  treated  by  arterial  surgery,  1,  or  11.2%,  recov- 
ered and  8,  or  88.8%,  died.  The  causes  of  death  in  the  unoperative 
series  were :  Spontaneous  hemorrhage,  4  times  ;  anesthesia,  1 ;  hem- 
orrhage from  puncture,  3.  Though  operative  relief  holds  out  the 
prospect  of  only  55.5%  of  cures,  this  percentage  contrasts  more  than 
favorably  with  11.2%  of  cures  when  a  watchful  policy  was  adopted. 
The  vessels  ligated  were : 

Common  carotid,  5  times,  with  2  cures  and  3  deaths. 

Common  carotid  and  splitting  of  sac,  once,  cured. 

Common  carotid  and  internal  jugular  vein,  1,  died. 

Common  carotid  and  division,  later  internal  and  external  carotids 
and  extirpation  of  sac,  1,  cured. 

Internal  carotid,  once,  cured. 

The  spontaneous  cure  was  reported  by  Lyot  and  Petit.  The  pa- 
tient had  had  scarlet  fever,  followed  by  a  severe  inflammation 
of  the  throat,  which  was  in  turn  succeeded  by  an  energetically 
pulsating    lump.       The    mass    collapsed    on    compression    of    the 

•  First  instalment.    Bulletin   School   of   Medicine,   University  of  Maryland,    1922,   vii,   84. 

*  Second  instalment.  Bulletin  School  of  Medicine,  University  of  Maryland,   1923,  vii,  125. 


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179 

common  carotid  artery  and  on  puncture  furnished  pure  blood. 
Though  the  patient  received  no  treatment  the  swelHng  diminished 
to  the  vanishing  point  in  three  months.  Ligation  of  the  internal 
carotid  artery  was  considered  but  rejected  on  account  of  the  poor 
condition  of  the  patient. 

The  most  striking  feature  in  this  group  of  cases  is  the  extreme 
youthfuhiess  of  the  patients,  12  being  recorded  as  under  21  years 
of  age.  This  is  a  matter  of  no  little  practical  significance,  in  so  far 
as  peritonsillar  abscess  is  a  very  common  disease  in  young  people. 
The  treatment  appropriate  to  the  latter  may  lead  to  grave  conse- 
quences if  applied  to  the  former  is  strikingly  attested  by  the  death 
of  4  of  these  patients.  Wulfif  was  spared  this  embarrassment  by 
ligating  the  common  carotid  artery,  but  Liston,  Vas,  Velebil  and 
Schlagenhaufer  were  not  so  fortunate.  Helman  under  similar  cir- 
cumstances changed  the  diagnosis  of  a  colleague  from  abscess  to 
aneurism.  This  patient  was  later  operated  upon  at  another  clinic 
but  died  of  a  postoperative  pneumonia.  Zamboni  saw  a  case  that 
others  had  diagnosed  as  abscess  and  advised  incision.  He  recognized 
the  nature  of  the  affection,  ligated  the  internal  carotid  artery  and 
saved  his  patient's  life.  On  the  other  hand  the  proclivity  of  this 
aneurism  to  spontaneous  rupture  has  led  to  equally  as  disastrous 
consequences  by  the  physician  in  charge  failing  to  recognize  its  na- 
ture. A  case  in  point  is  Neuffer's.  The  patient  had  had  an  angina 
tonsillaris,  followed  by  an  increasing  enlargement  of  the  left  tonsil. 
As  the  disease  progressed  the  food  passage  became  so  narrowed  as 
to  prevent  the  swallowing  of  solids  and  the  jaws  could  be  opened 
but  a  slight  distance.  On  the  12th  day  of  the  disease  the  patient 
had  a  profuse  hemorrhage  from  the  mouth  with  a  fatal  repetition 
the  next  day.  The  source  of  the  hemorrhage  remained  in  doubt  until 
autopsy  revealed  an  aneurism  of  the  internal  carotid  with  an  opening 
into  the  mouth.  Amongst  others  Johnson  lost  a  patient  under  quite 
similar  circumstances.  In  view  of  the  above-mentioned  catastrophies 
the  prompt  recognition  of  fauceal  aneurism  consecutive  to  scarlet 
fever,  influenza,  cervical  adenitis,  septic  sore  throat  and  inflamma- 
tory tonsillar  disease  is  of  the  utmost  importance,  as  a  false  move 
may  jeopardize  the  safety  of  the  patient's  life. 

In  addition  to  the  cases  tabulated  Molinie  (Rev.  de  Laryng., 
d'Otol.,  de  Rhinol.,  1921,  xiii,  97,  abstracted  by  Bourgeois  in  Jour, 
de  Chir.,  1921,,  xviii,  254)  cites  the  following  very  suggestive  case. 
The  patient,  a  woman,  who  had  suffered  with  an  otitis  media  from 
infancy,  underwent  an  operation  in  1898,  evidently  for  mastoiditis. 
In  1905  a  second  operation  was  interrupted  by  the  occurrence  of  a 
profuse  hemorrhage,  which  was  controlled  by  packing  the  wound 
with  gauze.  Ultimately  the  cavity  filled  up  with  a  dark  red  tumor 
from  which,  without  apparent  reason,  two  hemorrhages  occurred. 
The  lump  pulsated  neither  to  sight  nor  touch  unless  compressed 
when  an  indistinct  pulsation  was  both  seen  and  felt.  In  1906,  par- 
alysis of  the  facial  nerve  developed  and  in  1920,  of  the  auditory,  the 
glasso-pharyngeal,  the  pneumogastric  and  spinal  accessory.  Moline 
at  first  regarded  the  lesion  as  an  arterial  or  arteriovenous  aneurism, 
but  later  discarded  this  diagnosis  in  favor  of  dilatation  of  the  lateral 
sinus  and  bulb  of  the  internal  jugular  vein,  ascribing  the  pulsation 


ISO 

to  transmission  of  the  cerebral  pulse.  Another  doubtful  case  is  that 
reported  by  Majewski  (Kronika  Lekarska,  1903,  xxiv,  658,  trans- 
lated for  this  paper  by  A.  Kunkowski,  Univ.  of  Maryland).  The 
patient,  a  man  aged  64,  complained  of  a  pain  in  his  neck  of  three 
weeks'  duration,  and  for  two  weeks  he  had  had  a  swelling  in  the 
left  side  of  his  neck  the  size  of  an  apple.  The  overlying  skin  was 
neither  red  nor  raised.  The  lump  was  opened  under  ethyl  chloride 
applied  locally  and  a  small  amount  of  whitish  exudate  evacuated. 
Eight  days  later  blood  escaped  from  the  wound.  This  was  arrested 
by  tampons.  On  the  11th  day  during  the  process  of  redressing  there 
was  a  repetition  of  the  bleeding.  Again  tampons  staunched  the  flow 
of  blood.  Three  days  later  there  was  a  renewal  of  the  bleeding. 
This  time  the  flow  could  not  be  stopped  by  pressure,  so  the  patient 
was  taken  into  the  hospital,  where  an  incision  was  made  through  the 
previous  operative  site.  The  hemorrhage  was  now  found  to  be  deep 
seated.  First  the  internal  carotid  artery  was  tied  near  its  origin, 
but  the  bleeding  continuing,  the  vessel  was  still  further  exposed  and 
a  rent  from  which  the  blood  was  pouring  disclosed.  A  second  liga- 
ture was  placed  above  this  point.  The  bleeding  now  stopped,  but  the 
day  following  there  was  some  elevation  of  temperature;  a  pulse 
rate  of  120  and  a  fully  developed  hemiplegia.  Death  occurred  36 
hours  after  the  operation.  Helman  (Medycyna  I  Kronika  Lekarska, 
1909,  xliv,  685,  translated  for  this  paper  by  A.  Kunkowski,  Univ. 
of  Maryland)  refers  to  two  cases  of  large  vascular  pharyngeal  en- 
largements reported  by  Stoerck  (Special  Pathol,  by  Nothnagel,  Vol. 
xiii)  as  hematomata  from  which  when  opened  there  flowed  a  very 
profuse  hemorrhage,  the  arrest  of  which  proved  exceedingly  diffl- 
cult.  From  the  description  Helman  says,  it  is  extremely  difificult 
to  judge  whether  these  were  aneurisms  or  inflammatory  swell- 
ings with  bloody  contents.  The  same  author  mentions  on  the  same 
page  that  in  1895  Grossmann  showed  a  case  of  aneurism  of  the  throat 
before  the  Wiener  laryng.  Gesellschaft,  successfully  treated  by  liga- 
tion of  the  common  carotid  artery.  Schulte  (Monatshft.  f.  Ohrhlk., 
1904,  xxxviii,  117)  reports  the  following  case:  The  patient,  a 
woman,  aged  26,  consulted  him,  October  8,  1903,  for  a  running  from 
the  ear  and  a  left  hemicrania  of  some  weeks'  duration.  She  stated 
that  she  had  had  a  discharge  from  the  left  ear  off  and  on  for  many 
years.  On  examination  Schulte  discovered  a  superficially  smooth, 
bluish-red  growth  which  he  took  for  a  polypus  projecting  through 
a  rent  in  the  drum.  This  he  incised  and  was  rewarded  with  the 
escape  of  a  strong  stream  of  bright  red  blood.  The  flow  was  brought 
partially  under  control  by  gauze  packs  and  the  diagnosis  changed  to 
aneurism  of  the  internal  carotid.  As  from  time  to  time  there  was  a 
renewal  of  bleeding,  Dr.  Schneider  made  a  ligation  of  the  com- 
mon carotid  artery  on  October  IL,  1903,  apparently  with  success,  but 
the  next  day  the  bleeding  recurred  and  did  so  daily  until  October 
15th,  when  a  solution  of  gelatin  was  injected  into  the  patient.  There 
was  no  further  bleeding  until  October  26th,  then  a  daily  repetition  to 
October  30th  and  from  then  to  November  18th,  intermittently,  when 
following  a  total  of  19  injections  of  gelatine,  hemorrhage  finally 
ceased  and  the  patient  was  discharged  December  14,  1903. 


181 

Hirsch  (Monatshft.  f.  Ohrenhlk.  u.  Laryngo-Rhinol.,  1914,  xlviii, 
782)  states  Heine  found  in  a  53  year  old  man  an  aneurism  of  the 
internal  carotid.  Concerning  the  further  course  of  the  case  he  could 
add  nothing.  This  is  in  all  probability  the  same  case  that  Heine  re- 
ports in  the  Berlin,  klin.  Wochsft.,  1901,  xxxviii,  619,  under  the 
title  of  a  bleeding  from  the  internal  carotid  artery  in  consequence 
of  erosion.  The  patient,  a  woman,  aged  56,  was  admitted  to  the 
hospital,  February  13,  1900.  At  3  years  of  age  she  noticed  a  swell- 
ing behind  the  right  ear.  This  opened  at  the  age  of  6  and  discharged 
for  15  years.  Pain  was  first  experienced  in  August,  1899,  and  some 
days  later  a  right  hemicrania  developed.  At  the  base  of  the  right 
mastoid  process  was  a  fistula  filled  with  a  stinking  mass.  February 
16  a  radical  mastoidectomy  was  done  and  the  patient  was  discharged 
April  1.4,  though  the  wound  was  still  running.  She  was  readmitted 
August  27th  and  the  wound  curetted  the  same  day.  During  the 
manoeuvres  the  carotid  artery  was  exposed.  To  sight  it  did  not 
pulsate.  At  the  change  of  dressings,  September  1,  a  stream  of  dark 
blood  suddenly  escaped.  Pressure  on  the  common  carotid  did  not 
influence  the  flow.  Arrest  of  the  hemorrhage  was  finally  accom- 
plished by  iodoform  gauze  tampons.  He  attributed  the  hemorrhage 
to  an  erosion  of  the  internal  jugular.  The  bleeding  recurred  several 
times  thereafter,  but  was  easily  controlled  by  pressure.  The  woman, 
however,  did  badly  and  died  October  1,  1900. 

Autopsy  showed  that  the  blood  had  come  from  an  erosion  of  the 
internal  carotid  artery  superinduced  by  middle  ear  disease,  and  death 
was  caused  by  sepsis.  There  was  besides  a  pool  of  pus  in  the  vicinity 
of  the  petrous  bone  and  several  abscesses  in  the  brain. 

Benjamins  (Archiv  f.  Ohrhlk.,  1908,  Ixxvi,  240)  records  a  case  of 
aneurism  of  the  right  internal  carotid  with  fatal  bleeding  from  the 
external  auditory  meatus  from  necrosis  of  the  floor  of  the  canal 
following  the  insufflation  of  powdered  arsenic  by  a  "Medicine-Man" 
for  the  cure  of  a  discharge.  The  patient,  a  woman,  fell  into  Ben- 
jamins' hands  shortly  thereafter,  but  died.  Autopsy  revealed  an 
aneurism  of  the  internal  carotid,  but  I  could  not  determine  whether 
it  was  in  the  extracranial  portion  of  the  vessel  or  in  the  bony  canal. 
Certainly  there  were  no  pharyngeal  symptoms.  At  the  time  of  the 
hemorrhage  Benjamins  believed  the  source  of  the  bleeding  an  eroded 
jugular  vein  because  pressure  on  the  common  carotid  artery  failed  to 
stop  the  hemorrhage.  Quite  a  similar  case  is  Ruttin's  (Beitr.  z.  Anat., 
Phys.,  Path.  u.  Ther.  des  Ohres,  der  Nase  u.  des  Halses,  1919,  xi, 
224).  A  soldier  was  admitted  to  the  hospital,  January  17,  1918,  for 
bleeding  from  the  left  ear,  nose  and  mouth.  In  November,  1917, 
while  serving  on  the  Italian  front,  he  was  buried  by  the  explosion  of 
a  shell.  Since  1914,  he  had  had  a  discharging  left  ear  which  was  ren- 
dered worse  by  the  accident.  On  entrance  the  left  ear  was  dis- 
charging a  quantity  of  foul  pus  and  the  man  complained  of  severe 
pain  in  the  head.  After  admission  the  hemorrhage  from  the  nose, 
mouth  and  ear  renewed  itself  on  several  occasions.  Therefore  on 
January  18,  1918,  a  radical  mastoid  operation  was  undertaken.  On 
January  20,  there  was  renewed  bleeding  from  the  mouth  and  nose, 
and  the  man  died.    An  autopsy  showed  the  presence  of  an  aneurism 


182 

of  the  internal  carotid  artery  in  the  knee  of  the  carotid  canal  the 
wall  of  which  was  eroded.  Ehrmann  of  Mulhouse  (Bull,  et  mem 
de  la  Soc.  de  Chir.  de  Par.,  1^878,  n.s.,  Iv,  664)  reports  the  following 
very  suggestive  case.  The  patient,  a  man,  aged  22,  entered  the 
hospital  April  28,  1875  in  the  service  of  Dr.  Battenburg  for  an  an- 
gina tonsillaire  of  a  few  day's  duration  which  had  localized  on 
the  right  side.  He  complained  of  a  pain  in  the  right  submaxillary 
region,  dysphagia  and  fever.  May  1st,  toward  6  a.  m.,  the  abscess 
opened  spontaneously  into  the  throat,  at  the  same  time  a  stream  of 
red  blood  flooded  the  mouth.  This  ceased  spontaneously,  but  at 
9.30  a.  m.  a  new  hemorrhage  occurred.  It  was  as  sudden  in  onset 
as  the  first,  but  less  abundant.  Inspection  of  the  throat,  which  was 
accomplished  with  difficulty  owing  to  the  locking  of  the  jaws,  re- 
vealed redness,  edema,  and  tumefaction  of  the  velum  and  a  distinct 
impulse  was  imparted  to  a  palpating  finger.  Scarcely  a  half  hour 
later  there  was  a  repetition  of  the  bleeding  but  on  a  grander  scale. 
The  patient  was  now  in  a  state  of  syncope,  quite  exsanguinated,  pulse 
thready  and  extremities  cold.  Delay  was  no  longer  permissable,  so 
Ehrmann,  with  the  assistance  of  Battenburg,  made  a  ligation  of  the 
common  carotid  artery.  On  account  of  the  size  of  the  swelling  the 
vessel  had  to  be  ligated  below  the  omohyoid  muscle.  The  post-opera- 
tive course  was  favorable.  There  was  no  further  bleeding,  but  by  the 
end  of  the  first  week  there  was  a  tolerably  severe  febrile  reaction 
with  a  persistence  of  the  submaxillary  puffiness.  Finally  there  was 
a  discharge  into  the  mouth  of  a  fetid  pus.  At  no  time  were  there 
any  cerebral  or  nervous  symptoms.  In  the  beginning  there  was  some 
aphonia,  which,  however,  completely  disappeared  in  three  or  four 
days.  The  patient  was  discharged  cured,  June  18,  1875.  Ehrmann 
considered  this  a  case  of  erosion  of  the  internal  carotid  artery.  A 
number  of  similar  cases  have  been  reported,  i.  e.,  by  H.  Fischer 
(Arch.  f.  klin.  Chir.,  1899,  Iviii,  435),  Pepper  (Br.  Med.  JI.,  1882, 
ii.  892),  and  others. 

Billroth  (Arch.  f.  Ohrenhlk.,  1869,  iv,  53),  relates  that  a  prev- 
iously healthy  man,  aged  27,  was  admitted  to  the  hospital,  Nov.  23, 
1864,  on  account  of  syphilis.  November  28,  he  complained  of  pain 
on  movement  of  the  head  or  opening  of  the  mouth.  The  glands  be- 
neath the  mastoid  process  were  enlarged  and  sensitive,  pressure  on 
the  mastoid  process  was  without  pain.  On  December  2,  there  was  a 
sudden  bleeding  from  the  right  ear.  This  was  repeated  on  Dec.  3,  4, 
5,  but  to  a  lesser  degree  and  was  now  admixed  with  pus.  There  was 
a  diffuse,  red  puffiness  in  the  region  of  the  lower  jaw.  December  12 
and  13,  profuse  bleeding  from  the  mouth  and  nose  was  stilled  by 
pressure  to  the  carotid.  Dec.  13,  a  swelling  was  noticed  in  the  palatal 
region.  With  a  mirror  a  small  opening  in  the  lateral  wall  of  the 
pharynx  was  seen  from  which  pus  exuded.  On  account  of  these 
bleedings  a  ligation  of  the  rt.  C.  C.  A.  was  done.  On  Dec.  23  there 
was  again  a  free  hem.  from  the  nose,  mouth  and  ear  which  was 
brought  under  control  by  pressure  on  the  It.  C.  C.  A.  Dec.  27,  lig. 
of  the  It.  C.  C.  A.  was  practised;  Dec.  29,  repetition  of  the  hemorr- 
hage, exitus.     Autopsy  showed  a  fistulous  tract  beginning  in  the 


183 

right  auditory  canal  and  running  down  the  neck  to  an  eroded  in- 
ternal carotid  artery. 

Hermann  (Wiener  med.  Wochsft,  1867,  Nos  30,  31,  32),  accord- 
ing to  Schwartze,  (Arch.  f.  Ohrenhlk.,  1869,  iv,  294)  records  the 
case  of  a  girl,  aged  9,  left  otorrhoea  for  8  years,  on  February  20, 
1866,  who  had  had  a  hemorrhage  from  the  left  ear.  Had  the  pa- 
tient's condition  warranted  he  would  have  tied  the  C.  C.  A. ;  exitus 
Feb.  26,  1866,  autopsy  revealed  an  erosion  of  the  internal  carotid 
artery  in  its  course  through  the  carotid  canal. 

Zeroni  (Arch.  f.  Ohrenhlk.,  1901,  li,  98)  mentions  that  a  man, 
aged  29,  came  to  the  clinic  April  5,  1900.  He  had  had  a  discharge 
from  the  ears.  He  sought  relief  for  paralysis  of  the  right  side  of  the 
face,  pain,  noises,  dizziness  and  discharge  from  ear  all  in  existence 
since  Feb.  10.  April  6,  radical  mastoid  operation.  With  the  re- 
moval of  the  drains  on  April  13,  a  column  of  blood  spurted  up  from 
the  depths  of  the  wound,  stopped  by  packing.  April  15,  hemorrhage 
repeated  itself,  controlled  by  pressure  to  C.  C.  A.,  and  renewal  of 
the  gauze  packing.  Before  ligation  of  the  C.  C.  A.  could  be  prac- 
tised patient  died,  April  16,  1901. 

Autopsy  showed  an  erosion  of  the  internal  carotid  artery  in  its 
course  through  the  carotid  canal  and  pulmonary  tuberculosis. 


184 

BOARD  OF  TRUSTEES  ENDOWMENT  FUND 
UNIVERSITY  OF  MARYLAND 

Report  of  B.  Mkrrill  Hopkinson^  M.  D.,  Treasurer, 
Covering  the  period  January  10,  1922,  to  January  9,  1923 


FACULTY  OF  PHYSIC  FUND 

1922 

Jan      10— Balance  Central  Savings  Bank $1,732.96 

Feb.      6—1  1,000  Lake  Erie  &  Western  R.  R. 

5% $919.86 

April     1— Interest  Cent.  Sav.  Bank,  Oct.-April  26.72 

April  24—1  1,000  Consol.  Coal  Co.,  5% 915.53 

Oct.       1,— Interest  Cent.  Sav.  Bank,  April-Oct.  12.78 

Dec.    11— Md.  Casualty  Co.,  Treasurer's  bond.    1,835.39 

1923 
Jan.       8— Interest  on  all  bonds  to  date 12.50       1,864.38 


$1,847.89    $3,636.84 
1,847.89 


Jan.       9 — Balance  Central  Savings  Bank 1,788.95 

This  Fund  consists  of  : 

2  1,000  American  Agri.  Chem.  Co.,  5% 1,963.06 

1      500  Cent.  Hudson  G.  &  E.,  7% 500.00 

3  1,000  Cent.  Hudson  G.  &  E.,  7% 3,000.00 

1   1,000  G.,  Car.  &  Northern,  5% 1,000.00 

5      500  Regents  Univ  .of  Maryland,  5% 2,500.00 

1  1,000  Public  Serv.  Corp.,  5% 1,000.00 

1   1,000  Minneapolis  Gas  Light  Co.,  5% 1,000.00 

1   1,000  Edison  Elec.  Co.,  5% 1,000.00 

I  1,000  Fairmount  &  Clarks'bg  Trac.  Co.,  5%  1,000.00 

1  1,000  Consol,  Gas.,  Balto.,  4^2% 980.00 

2  1,000  Omaha  &  Council  Bluffs  St.  Ry.,  5%  .  1,940.00 

2  1,000  Cincin.  Gas  &  Trans.  Co.,  5% 1,960.00 

2  1,000  West  Penn  Power  Co.,  57^ 1,940.00 

2  1,000  Cumberland  Co.  P.  &  L.,  5% 1,940.00 

2  1,000  Louisiana  Port  Serial  Com.,  5% 2,000.00 

1   1,000  Grand  Trunk  Ry.,  7% 1,000.00 

1   1,000  Penna.  R.  R.  6y2% 1,000.00 

1  1,000  Balto.  Co.,  5% 1,000.00 

1   1,000  Lake  Erie  &  Western  R.  R.,  5% 1,000.00 

1   1,000  Consol.  Coal  Co.,  5% •      1,000.00 

1  500  First  Liberty  Loan,  3%% 500.00 

3  1,000  Third  Liberty  Loan,  4Vi% 3,000.00 

2  1,000  Fourth  Liberty  Loan,  4%% 2,000.00 

1      500  Fourth  Liberty  Loan,  4%% 500.00 

$36,512.01 


185 

GENERAL   ENDOWMENT  FUND 

1522 

Jan.     10— Balance  Cent.  Sav.  Bank $1,084.29 

Feb.      ^-1   1,000  Dutch  East  Indies  6%  Gold 

Bond   $950.83 

April     1— Interest  Cent.  Sav.  Bank,  Oct.-April  14.52 

May    30— Rent  Box  Colonial  Trust  Co 10.00 

Sept.  26 — Adjusted  Int.  Dutch  E.  Indies  Bond  .91 

Oct.       1— Interest  Cent.  Sav.  Bank,  April-Oct.  7.57 

Ian.       8,   1923— Interest  on  all  bonds  to  date.  .  641.91 


$961.74  $1,748.29 
961.74 

Jan.       8— Balance  Cent.  Sav.  Bank 786.55 

This  Fund  consists  of : 

1      500  Regents  Univ.  of  Maryland,  5%  .  . .  .  500.00 

1   1,000  Ga.  &  Ala.,  5% ' 1,000.00 

1   1,000  Ga.,  Car.  &  Northern,  5% 1,000.00 

1   1,000  Omaha  &  Council  Bluffs  R.  &  B.,  S%  1,000.00 

1  1,000  Consol.  Coal  Co.,  6% 1,000.00 

2  500  Consol.  Coal  Co.,  6% 1,000.00 

2  1,000  St.  los.  Ry.  L.  N.  &  P.  Co 2,000.00 

1   l.,000  Edison  Elec.  Co.,  5% 1,000.00 

1   1,000  Baltimore  Co.,  5%% 1,000.00 

1   1,000  Dutch  E.  Indies,  6% 1,000.00 

1      500  First  Liberty  Loan,  2,^2% 500.00 

1   1,000  Third  Liberty  Loan,  4%% 1,000.00 

1  500  Fourth  Liberty  Loan,  4^/4% 500.00 

$13,286.55 

CATHERINE  GIBSON   EUND 

1922 

Jan.     10— Balance  Cent.  Sav.  Bank $699.43 

April     1— Interest  Cent.  Sav.  Bank,  Oct.-April  13.88 

Oct.       1.— Interest  Cent.  Sav.  Bank,  April-Oct.  14.87 

Jan.       8,  1923— Interest  on  all  bonds  to  date.  .  81.88 

810.06 

This  Fund  consists  of  : 

2  500  Regents  University  of  Maryland,  S%  $1,000.00 
1      500  Fourth  Liberty  Loan,  4^/4% 500.00 

$2,310.06 

CHARLE.S  M.  HITCHCOCK  FUND 
1.922 

Jan.     10— Balance  Cent.  Sav.  Bank $215.96 

April     1— Interest  Cent.  Sav.  Bank 3.47 

June    10— Scholarship,  G.  S.  Kerdasha $125.00 

June    10 — Scholarship,  J.  J.  Krager 125.00 

$250.00 


186 

Oct.       1— Interest  Cent.  Sav.  Bank,  April-Oct.  2.63 

Jan.       8,  1923— Interest  on  all  bonds  to  date. .  250.00 

472.06 
Less 250.00 

Jan.       8,  1923— Balance  Cent.  Sav.  Bank 222.06 

This  Fund  consists  of  Ten  500  Regents  Univer- 
sity of  Maryland,  5% 5,000.00 

$5,222.06 

LEO  KARLINSKY  FUND 
1.922 

July     1.8— Interest  6  months  (3)  1,000  Gt.  No. 

Ry.  Co.,  7% $105.00 

Oct.       1 — Interest  6  months  Cent.  Sav.  Bank. .  .70 

1923 
Jan.       &— Interest  6  months  (3)  1,000  Gt.  No. 

Ry.  Co.,  7% 105.00 

Jan.       8— Balance  Cent.  Sav.  Bank $210.70 

This  Fund  consists  of  Three  1,000  Gt.  No.  Ry. 

Co.  7%  bonds 3,000.00 

$3,210.70 

LEON  FRANK  FUND 

1.922 

Jan.     10— Balance  Cent.  Sav.  Bank $129.74 

April     1— Interest  Cent.  Sav.  Bank,  Oct.- April  2.15 

June    1.0— Scholarship,  D.  R.  Newcomer $125.00 

Oct.       1— Interest  Cent.  Sav.  Bank,  April-Oct.  1.73 

Jan.       8,  1923— Interest  on  all  bonds  to  date.  .  1.35.00 

$268.62 
Less 125.00 

Jan.     8,  1923— Balance  in  Cent.  Sav.  Bank...  $143.62 

This  Fund  consists  of  : 

1      500  Central  Hudson  Gas  &  Elec.  7%  bond  500.00 

1  1,000  St.  Jos.  N.  L.  &  P.  Co.,  5%  bond. . . .  1,000.00 
1  1,000  Omaha  &  Council  Bluffs  Ry.  &  B.  5% 

bond 1,000.00 

$2,643.62 

RANDOLPH  WINSLOW  FUND 
1922 

Jan.     10— Balance  Cent.  Sav.  Bank $71.56 

April     1 — Interest  Cent.  Sav.  Bank,  Oct.-April  .97 
May       — Interest  5  500  Regents  Univ.  of  Md., 

5% 62.50 


187 

June    10— Scholarship,  L.  A.  Schultz $125.00 

Oct.       I— Interest  Cent.  Sav.  Bank,  April-Oct.  .60 

Nov.    18— Interest  5  500  Regents  Univ.  of  Md., 

5% 62.50 

$198.13 
125.00 

1923  • 

Jan.       8— Balance  Cent.  Sav.  Bank $73.13 

This  Fund  consists  of  5  500  Regents  University 

of  Maryland 2,500.00 

$2,573.13 

DAVID  STREET  SCHOLARSHIP  FUND 

L922 

Jan.       1— Balance  Cent.  Sav.  Bank $50.20 

April     1 — Interest  Cent.  Sav.  Bank,  Oct.-April  .90 

Oct.       1— Interest  Cent.  Sav.  Bank,  April-Oct.  1.12 

1923 

Jan,       1 — Interest  on  all  bonds  to  date 20.06 

Jan.       g— Balance  Cent.  Sav.  Bank $72.28 

This  Fund  consists  of  : 

3  100  First  Liberty  Loan,  3V2% 300.00 

1   100  Second  Liberty  Loan,  4%% 100.00 

1     50  Fourth  Liberty  Loan,  4%% 50.00 

$522.28 
DENTAL  Fund 
1522 

Jan.     10— Balance  Cent.  Sav.  Bank $25.70 

April     1 — Interest  Cent.  Sav.  Bank,  Oct.April.  .50 

Oct.       1— Interest  Cent.  Sav.  Bank,  April-Oct.  .50 

$26.70 

BURT  J.  ASPER  MEMORIAL  FUND 

Received  from  Nathan  Winslow,  M.  D.,  sixty  dollars  for  the 
above  Fund,  the  interest  from  which  is  to  be  expended  in  the  pur- 
chase of  either  medical  books  or  journals  for  the  library  of  the 
University  of  Maryland,  School  of  Medicine,  inscribed  with  a  suit- 
able book  plate,  in  amounts  as  follows :  Charles  R.  Law,  $5.00 ; 
E.  E.  Nichols,  $5.00;  Charles  A.  Waters,  $10.00;  Vernon  L.  Oler, 
$5.00;  P.  P.  McCain,  $10.00 ;  Adolph  Mulstein,  $15.00;  Anonymous, 

$10.00 ;  upon  June  28,  1922 $60.00 

Oct.     5— J.  J.  Greengrass 15.00 

Oct.  11— Arthur  M.  Shipley LO.OO 

Oct.     1 — Interest  Central  Savings  Bank,  October-April  .60 

Oct.  23— J.  R.  Agnew 10.00 

Nov.  10— K.  B.  Jones 5.00 

Nov.  10— R.  A.  Allgood 5.00 

Nov.  2A — Samuel  Moore 5.00 

Dec.  14— Randolph  Winslow ' 5.00 

Jan.     8,  1923— Balance  Central  Savings  Bank $115.60 


188 

DAUGHTERS  OF  THP:  AMERICAN  REVOLUTION  FUND 

Received  from  Mrs.  J.  J.  Nance  check  for  one  thousand  dollars,  to 
endow  a  bed  in  the  Maternity  Ward  of  the  University  of  Maryland 
Hospital,  in  the  name  of  the  Daughters  of  the  American  Revolution : 
1922 

Ian.     18     $1,000.00 

Jan.     25—1,  1,000  Dutch  East  Indies  6%  bond    $945.00 

Ian.     25 — Accrued  interest,  23  days 3.83 

Jan.     25— Charges  Baker,  Watts  &  Co .17 

Mar.    10— Exchange  1  1,000  Dutch  East  Indies 
25  years,  6%,  1  1,000  Dutch  East 
50  years,  6%,  interest  1  mo.  5  days  15.03 
i\pril     1 — Interest  Cent.  Sav.  Bank,  Oct.-April  .33 
Sept.  21— Interest  6  mos.  1  1,000  Dutch  E.  In- 
dies, 6%   30.00 

Sept.  26 — Adjusted  interest  .91 

Oct.       1 — Interest  Cent.  Sav.  Bank,  April-Oct.  1.30 

$949.91     $1,046.66 
949.91 

Jan.       8,  1923— Balance  Cent.  Sav.  Bank....  $96.75 

This  Fund  consists  of  1  1,000  Dutch  East  Indies 

6%  1,000.00 

$1,096.75 

CHARLKS  I'RICK  RESEARCH   FUND 

1922 

Jan.     10— Balance  Cent.  Sav.  Bank $425.73 

April     1 — Interest  Cent.  Sav.  Bank,  Oct.-April.  8.60 

Oct.       1— Interest  Cent.  Sav.  Bank,  April-Oct.  8.93 

1923 

Jan.       8 — Interest  on  all  bonds  to  date 31.88 

Jan.       8— Balance  Cent.  Sav.  Bank $475.14 

This  Fund  consists  of  1  500  Fourth  Lib.  Loan, 

4V*%   500.00 

$975.14 

JOHN  C.  HEM  METER  AND  WIFE  FUND 

1922 

Jan.     10— Balance  Cent.  Sav.  Bank $388.18 

April     1 — Interest  Cent.  Sav.  Bank,  Oct.-April.  7.47 

Oct.       1— Interest  Cent.  Sav.  Bank,  April-Oct.  10.50 

1923 

Jan.       8 — Interest  on  all  bonds  to  date 305.00 

Jan.       8 — Balance  Cent.  Sav.  Bank 711.15 

This  Fund  consists  of : 

1  1,000  Chicago  City  Ry.,  5% 1,000.00 

1  1,000  Chicago  Railway's,  5% 1,000.00 


189 

1.  1,000  Minneapolis  St.  Rv.  &  St.  Paul  Ry., 

5% \ 1,000.00 

2  1,000  Third  Liberty  Loan,  4%% 2.000.00 

1  1,000  Grand  Trunk  of  Canada,  7% 1,000.00 


$6,711.15 

LAW   FUND 

1922 

Jan.     10— Balance  Cent.  Sav.  Bank $172.83 

April     1— Interest  Cent.  Sav.  Bank,  Oct.-April  3.40 

Oct.       1— Interest  Cent.  Sav.  Bank,  April-Oct.  3.50 


Jan.       8,  1923— Balance  Cent.  Sav.  Bank....  $179.73 

PHARMACY  FUND 

1922 

Jan.     1,0— Balance  Cent.  Sav.  Bank $47.78 

April     1 — Interest  Cent.  Sav.  Bank,  Oct.-April.  .90 

Oct.       1— Interest  Cent.  Sav.  Bank,  April-Oct.  .90 

Jan.       8,  1923— Balance  Cent.  Sav.  Bank $49.58 

TOTAL  PAR  VALUE  OF  ALL  FUNDS 

Faculty  of  Physic  Fund $36,512.01 

General  Endowment  Fund 13,286.55 

Catherine  Gibson  Fund 2,310.06 

Charles  M.  Hitchcock  Fund 5,222.96 

Leo  Karlinsky  Fund 3,210.70 

Leon  Frank  Fund 2,643.62 

Randolph  Winslow  Fund 2,573.13 

David  Street  Scholarship  Fund 522.28 

Dental  Fund 26.70 

Burt  J.Asper  Fund 115.60 

Daughters  of  the  American  Revolution  Fund 1,096.75 

Charles  Frick  Research  Fund 975.14 

John  C.  Hemmeter  and  Wife  Fund 6,711.15 

Law  Fund   179.73 

Pharmacy  Fund 49.58 

$75,435.96 


January  19,  1923 
We  have  this  day  examined  the  cash  balances  and  securities  of  all 
the  endowment  funds  of  the  University  of  Maryland  in  the  hands  of 
the  Secretary-Treasurer,  and  found  them  to  be  correct. 

(Signed)     J.  M.  H.  ROWLAND. 
HORACE  M.  DAVIS. 


190 

EDITORIAL 

THE  BURT  J.  ASPER  MEMORIAL  FUND 

Since  the  last  announcement  the  following  contributions  have  been 
received : 

R.  Winslow,  class  of  1873,  Baltimore $  5.00 

S.  W.  Moore,  D.  D.  S.,  Baltimore 5.00 

Previously  acknowledged 105.00 

Total $115.00 

We  have  been  working  on  this  Fund  for  a  year  now.  So  far  the 
response  has  not  been  as  liberal  as  had  been  hoped  considering  the 
nature  of  the  memorial.  Dr.  Burt  J.  Asper  was  a  member  of  the 
class  of  1911.  When  the  call  came  for  physicians  to  serve  in  the 
Great  War,  he  did  not  hesitate  but  offered  his  services  immediately 
to  the  Government.  He  was  granted  a  commission  in  the  Navy  and 
assigned  to  the  ill-fated  Cyclops  which  with  its  entire  crew  myster- 
iously disappeared.  Surely  the  perpetuation  of  his  memory  is  a 
worthy  cause.  At  the  same  time  that  you  do  this,  you  also  supply 
his  successors  with  an  absolute  essential  in  the  acquirement  of  a 
well-rounded  medical  education,  namely  the  best  literature.  In  order 
that  the  next  report  be  more  becoming  the  object,  let  us  urge  you 
to  send  in  your  contribution  at  once.  There  is  no  need  to  remind 
you  that  the  principal  is  held  in  perpetual  trust  by  the  Endowment 
Committee  of  the  University  of  Maryland  and  only  the  interest 
therefrom  can  be  appropriated  for  the  purchase  of  medical  journals 
or  text-books. 

ALUMNI  ACTIVITIES 

The  Alumni  Association  will  establish  headquarters  at  the  Hotel 
Raleigh  during  the  coming  meeting  of  the  Southern  Medical  Associ- 
ation to  be  held  November  12,  1923.  Due  notice  of  the  arrange- 
ments will  be  forwarded  the  alumni  at  the  proper  time. 

The  Annual  Meeting  of  the  Alumni  Association  will  be  held  dur- 
ing Commencement  Week.  The  programme  will  be  made  known 
sufficiently  early  for  those  intending  to  participate  to  make  proper 
preparations  for  their  attendance.  It  is  sincerely  hoped  that  all  those 
who  can,  will  be  present. 

DEATHS 

Dr.  George  H.  West,  Fairmont,  N.  C,  class  of  1889  and  Jefferson 
Medical  College,  class  of  1892;  at  one  time  lecturer  on  histolog}-, 
Jefferson  Medical  College ;  formerly  connected  with  the  Jefferson, 
Polyclinic  and  Presbyterian  Hospitals,  Philadelphia ;  for  25  years 
a  practitioner  in  Philadelphia;  died  October  30,  1.922,  aged  60. 

Dr.  Robert  M.  Bolenius,  Lancaster,  Pa.,  class  of  1873 ;  aged  75 ; 
died  October  13,  1922. 

Dr.  John  Henry  McMullan,  Edenton,  N.  C,  class  of  1876 ;  aged 
73 ;  died  December  10,  1922,  following  an  appendectomy. 

Dr.  Irving  Smith  Coburn,  Milton,  Vt.,  B.  M.  C,  class  of  1901 ; 
state  senator ;  aged  48 ;  died  January  20,  1923,  from  septicemia. 


191 

Dr.  Wilbur  Phelps  Morgan,  Baltimore,  class  of  1862;  aged  81; 
died  December  20,  1922,  from  senility. 

Dr.  Enos  Walter  Dickson  Wright,  Langley,  S.  C,  B.  M.  C,  class 
of  1894;  aged  50;  died  December  4,  1922,  from  a  fractured  skull. 

Dr.  Orion  Baum,  Vine,  Va.,  P.  &  S.,  class  of  1885;  aged  64;  died 
January  9,  1923. 

Dr.  Prince  Cooper,  Van,  W.  Va.,  P.  &  S.,  class  of  1.915 ;  aged  36 
died  December  7,  1922,  from  meningitis. 

Dr.  L.  Theophilus  Hill,  Abbeville,  S.  C,  class  of  1882;  aged  70 
died  December  26,  1932,  from  cerebral  hemorrhage. 

Dr.  Thomas  J.  Talbott,  Jr.,  Baltimore,  class  of  1895;  aged  50 
died  January  1,  1923,  from  cerebral  hemorrhage. 

Dr.  John  R.  Wheless,  Spring  Hope,  N.  C,  P.  &  S.,  class  of  1891 
aged  54 ;  died  December  4,  1922,  from  cerebral  hemorrhage. 

Dr.  Edward  F.  Milholland,  Baltimore,  class  of  1858;  a  prominent 
practitioner  in  Baltimore  for  more  than  half  a  century ;  aged  85 
died  December  23,  1922,  from  pneumonia. 

Dr.  Archibald  Cheatham,  Durham,  N.  C,  class  of  1888;  aged  58 
died  December  10,  1922,  from  heart  disease. 

Dr.  Columbus  Drew,  Jacksonville,  Fla.,  Washington  University, 
School  of  Medicine,  class  of  1869,  Medical  Department  of  Univer- 
sity of  the  City  of  New  York,  class  of  1879;  aged  76;  died  December 
U,  1922. 

Dr.  Alber  J.  Remsburg,  Warfordsburg,  Pa.,  class  of  1874;  aged 
76;  died  December  7,  1922,  from  senility. 

Dr.  Alexander  R.  Mitchell,  Hereford,  Md.,  class  of  1877;  aged 
67 ;  died  December  12,  1922. 

Dr.  Eugene  Justin  Butler,  Wilkes-barre,  Pa.,  P.  &  S.,  class  of 
1893 ;  aged  61 ;  died  November  6,  1922,  from  cerebral  hemorrhage. 

Dr.  William  S.  Cline,  Woodstock,  Va.,  Washington  University, 
School  of  Medicine,  class  of  1867;  died  November  19,  1922,  from 
a  fall. 

Dr.  Charles  T.  Horn,  Lehighton,  Pa.,  P.  &  S.,  class  of  1878;  aged 
74 ;  died  November  20,  1922,  from  paralysis. 

Dr.  Thomas  K.  Galloway  Baltimore,  class  of  1876;  died  December 
24,  1922. 

Dr.  Elias  C.  Fleming,  Hurlock,  Md.,  P.  &  S.,  class  of  1878;  died 
October  31,  1922,  aged  68. 

Dr.  B.  Merrill  Hopkinson,  Baltimore,  class  of  1885  ;  a  devoted 
and  most  valued  alumus ;  prominent  for  many  years  in  the  musical, 
athletic  and  professional  life  of  Baltimore;  died  February  22,  1922, 
from  a  complication  of  diseases,  aged  65.  His  loss  is  a  severe  blow 
to  the  University  of  Maryland.  For  many  years  he  has  given  his 
best  efforts  towards  the  upbuilding  of  his  Alma  Mater.  He  has 
been  a  leading  spirit  in  every  one  of  its  foreward  movements.  To 
a  large  part  the  success  of  the  Centennial  Celebration  was  due 
to  his  help  and  encouragement.  For  many  years  he  has  been  treas- 
urer of  the  Endowment  Committee  of  the  University  of  Maryland. 
The  annual  alumni  meetings  will  be  the  poorer  by  his  absence.  An 
enthusiastic,  loyal  supporter,  a  representative  of  the  best  type  of  the 


192 

old  University  of  Maryland,  he  stood  for  the  good  and  the  true, 
we  will  miss  him  sorely.  God  bless  you  and  may  your  Soul  rest 
in  peace. 

Dr.  John  W.  Kidd,  Burnsville,  W.  Va. ;  P.  &  S.,  class  of  1884; 
formerly  a  member  of  the  state  legislature;  aged  66;  died  February 
2,  1923,  from  cerebral  hemorrhage. 

Dr.  Joshua  Royston  Green,  Towson,  Md.,  class  of  1899;  aged  47; 
died  February  22,  1823,  from  pneumonia. 

Dr.  Henry  Latimer  Rudolph,  Gainesville,  Ga.,  class  of  1902;  aged 
43 ;  died  recently,  from  pneumonia.  Dr.  Rudolph  was  one  of  the 
most  esteemed  members  of  his  class  and  beloved  by  all  with  whom 
he  came  in  contact.  He  had  attained  an  enviable  reputation  as  a 
specialist  in  pediatrics  in  his  home  town. 

Dr.  Horace  Benjamin  Coblentz,  Washington,  D.  C,  class  of  1896 ; 
aged  51  ;  died  January  24,  1923,  from  heart  disease. 

Dr.  Christopher  C.  Webb,  Warrensburg,  111.,  class  of  1881 ;  aged 
72;  died  December  1,  1922,  from  cerebral  hemorrhage. 

Dr.  John  h.  Ray,  Burnsville,  N.  C.,  P.  &  S.,  class  of  1887;  aged 
61 ;  died  October  27,  1922. 

Dr.  Albert  Leigh  Sanders,  Baltimore,  class  of  1905 ;  aged  53 ; 
died  recently. 

Dr.  Harry  C.  Cline,  Front  Royal,  Va.,  class  of  1876 ;  aged  74 ;  died 
September  29,  1922,  from  pernicious  anemia. 

Dr.  Frank  T.  Shaw,  Westminster,  Md.,  class  of  1864;  aged  82. 
for  many  years  one  of  the  most  prominent  practitioners  of  Carroll 
county;  died  February  24,  1923,  from  uremia. 


BOOK  REVIF.WS 


Physics  and  Chemistry  for  Nurses.  By  A.  R.  Bliss,  Jr.,  A.  M., 
Phm.  D.,  M.  D.,  Lecturer  on  Chemistry  and  Materia  Medica,  Grady 
Hospital  Training  School  for  Nurses,  Atlanta ;  Professor  of  Phar- 
macology, Emory  University,  School  of  Medicine ;  Formerly  Pro- 
fessor of  Chemistry  and  Pharmacology,  Graduate  School  of  Medi- 
cine, University  of  Alabama.  And  A.  H.  Olive,  A.  M.,  Ph.  Ch., 
Phm.  D. ;  Lecturer  on  Chemistry,  Hillman  Hospital  Training  School 
for  Nurses,  Birmingham ;  xA.ssociate  Roentgenologist,  Hillman  Hos- 
pital ;  Formerly  professor  of  Physics  and  Chemistry,  Howard  Col- 
lege; Associate  Professor  of  Chemistry,  Graduate  School  of  Medi- 
cine, University  of  Alabama.  70  Illustrations.  Third  Edition, 
Thoroughly  Revised  and  Rewritten  and  Conforming  to  the  Require- 
ments of  the  Standard  Curriculum  of  The  National  League  of  Nur- 
sing Education.  1923.  Cloth,  $2.50  Net,  Philadelphia  and  London  : 
J.  B.  Lippincott  Company. 

Directresses  of  training  schools  for  nurses  will  find  this  book  bet- 
ter adapted  to  the  needs  of  the  nurses  in  training,  than  ever.  Though 


193 

of  necessity  the  subjects  must  be  discussed  in  rather  a  brief  man- 
ner, still  the  contents  are  sufficiently  full  to  meet  the  needs  of  the 
nurse.  The  style  is  excellent,  the  language  clear  and  simple.  It  is 
one  of  the  best  books  of  the  kind,  it  has  been  our  good  fortune  to 
review.  We  recommend  it  with  the  utmost  confidence  that  the  pur- 
chaser will  be  well  pleased. 

The  Successful  Physician.  By  Verlin  C.  Thomas,  M.  D.,  Visiting 
Physician  to  Franklin  Hospital,  San  Francisco.  Octavo  of  303 
pages.  Philadelphia  and  London :  W.  B.  Saunders  Company,  1923. 
Cloth,  $4.00  net. 

The  recent  graduate  when  launching  into  the  practice  of  medicine 
is  suddenly  confronted  with  many  problems  that  were  not  taught 
in  the  curriculum.  These  must  be  solved  and  solved  correctly,  if 
his  efforts  to  gain  a  clientele  are  to  be  successful.  This  book  tells 
how  to  attract  and  hold  patients ;  discusses  the  matter  of  choice  of 
location ;  comments  upon  changing  ability  into  income ;  considers 
office  equipment  and  management  and  deals  with  such  other  ques- 
tions as  the  doctor  and  his  investments,  the  physician  and  the  phar- 
macists, the  physician  and  the  special  nurse,  the  physician  and  the 
law,  ethics,  insurance,  demeanor  in  critical  cases.  All  these  are  live 
problems ;  questions  of  the  utmost  concern  to  the  medical  novitiate 
that  have  to  be  decided  and  acted  on  promptly.  This  side  of  the 
practice  of  medicine  has  been  sadly  neglected  my  medical  writers. 
Any  book  that  will  help  the  doctor  over  these  rough  spots,  any  ad- 
vice that  points  out  the  high-road  to  the  cap-stone  that  is  the  ulti- 
mate goal  of  all  engaged  in  medicine,  namely,  success,  is  indeed  a 
welcome  addition  to  the  medical  literature.  Thomas  has  succeeded 
in  an  admirable  fashion  in  presenting  this  phase  of  medicine  to  his 
reader.  The  advice  he  gives  is  sound  and  practicable.  The  book  is 
well  worth  a  careful  perusal  not  alone  by  the  recent  but  also  the 
hardened  practitioner. 

Generalized  Pain.  Clinical  Symptomatology  of  Internal  Diseases. 
By  Professor  Norbert  Ortner,  M.  D.,  Vienna.  Only  authorized 
Translation  into  the  English  language  of  the  second  German  edition. 
By  Francis  J.  Rebman.  With  an  introduction  by  Thomas  Webster 
Edgar,  M.  D.,  New  York.    New  York :   Medical  Art  Agency. 

This  book  discusses  pain  in  its  relationship  to  internal  maladies, 
abdominal  conditions  excepted  which  have  been  thoroughly  analyzed 
in  an  independent  volume.  By  this  book  it  is  possible  for  the  physi- 
cian to  visualize  the  pathology  causing  the  pain  without  the  consulta- 
tion of  numerous  text-books.  The  human  family  will  stand  almost 
any  discomfort  save  pain.  It  is  this  sympton  that  brings  most  peo- 
ple to  the  doctor,  therefore  it  is  of  prime  necessity  that  the  physician 
be  cognizant  of  the  circumstances  giving  rise  to  pain  in  any  particu- 
lar region.  Misinterpretation  of  the  significance  of  pain  often  leads 
to  unnecessary,  yea,  useless  operations.  It  is  not  an  uncommon  oc- 
currence of  spinal  cord  irritation  from  tuberculosis  to  announce  itself 
by  abdominal  pain  which  mimics  very  closely  appendicitis,  ovarian 
inflamatory  disease,  etc.  Many  other  conditions  betray  their  pres- 
ence by  pain  in  a  remote  organ.    Therefore  pain  must  be  interpreted 


194 

correctly,  if  the  patient's  best  interests  are  to  be  served.  Pain  in  the 
heart,  in  the  thorax,  in  the  head,  in  the  extremities,  in  the  bones  are 
a  few  of  the  subdivisions  of  this  book.  The  book  is  a  very  valuable 
contribution  to  the  medical  literature  and  American  physicians  are 
indeed  fortunate  to  have  at  hand  in  readily  accesible  form  a  most 
excellent  translation  into  English  of  the  German. 

Essentials  of  Surgery.  A  Text-Book  of  Surgery.  For  Student 
and  Graduate  Nurses  and  for  those  Interested  in  the  Care  of  the 
Sick.  By  Archibald  Leete  McDonald,  M.  D.,  formerly  in  Charge  of 
the  Department  of  Anatomy,  University  of  North  Dakota;  Lecturer 
on  Surgery,  Nurses  Training  School,  St.  Luke's  Hospital,  Duluth, 
Minnesota.  49  Illustrations.  Second  Edition,  Revised.  Philadel- 
phia and  London :  J.  B.  Lippincott  Company.  1923.  Cloth,  $2.50 
net. 

This  book  covers  in  simple  language  the  general  principles  of  sur- 
gical diseases  and  the  resulting  pathological  changes.  Under  ap- 
propriate sections  the  more  important  of  the  surgical  lesions  invol- 
ving the  special  organs  are  adequately  considered.  Both  the  gradu- 
ate and  undergraduate  nurse  can  study  the  material  set  forth  with 
benefit  to  themselves.  It  is  superfluous  to  remark  that  the  well  in- 
formed nurse  can  render  more  intelligent  treatment  to  the  patients 
under  her  care.  McDonald  has  succeeded  in  writing  a  thoroughly 
reliable  text-book  exceptionally  well  adapted  to  the  needs  of  those 
for  whom  it  is  especially  designed. 

How  We  Resist  Disease.  By  Jean  Broadhurst,  Ph.  D.,  Assistant 
Professor  of  Biology,  Teachers  College,  Columbia  University.  138 
Illustrations  and  4  color  plates.  Philadelphia  and  London :  J.  B. 
Lippincott  Company.     1923.    Cloth,  v$2.50  net. 

This  book  is  primarily  an  introduction  to  the  study  of  bacteriology 
and  secondarily  an  outline  on  immunity.  It  is  sufficiently  embracive 
to  give  the  nurse  a  clear  insight  into  the  infectious  diseases,  the  or- 
ganisms causing  these  diseases,  natural  and  artificial  antibodies,  vac- 
cines, anaphylaxis,  etc.  It  should  prove  most  helpful  to  nurses  de- 
sirous of  acquiring  an  intelligent  insight  into  the  principles  of  im- 
munology. It  is  well  illustrated,  written  in  clear  and  concise  lan- 
guage, and  sufficiently  fulsome  for  the  purposes  for  which  it  was 
conceived.  Pupils  in  nursing  will  find  it  a  quite  satisfactory  mono- 
graph. 

The  Biology  of  Death.  By  Raymond  Pearl  (The  Johns  Hopkins 
University).  Philadelphia  and  London:  J.  B.  Lippincott  Company. 
1922.    Cloth,  $2.50  net. 

During  recent  years  much  progress  has  been  made  by  the  aid  of 
biology,  both  general  and  experimental  and  statistical  and  acturial 
science  into  the  problems  underlying  the  mysteries  of  natural  death. 
By  natural  and  supernatural  means,  mankind  has  endeavored  to  pro- 
to  our  knowledge  of  natural  death  and  the  causes  which  determine 
the  span  of  life.  Pearl  has  collected  together  the  known  facts  con- 
cerning this  most  vital  subject  and  woven  them  together  into  a  com- 
posite whole  in  a  book  of  275  pages.    He  has  brought  together  many 


195 

interesting  facts  dealing  with  natural  death  and  has  covered  the  sub- 
ject most  thoroughly.  Seekers  after  knowledge  upon  this  most  in- 
long  the  individual's  life.  Biological  science  has  contributed  much 
triguing  subject  will  find  this  book  most  satisfactory  in  its  enunci- 
ation of  the  problems  concerned.  It  ofifers  to  the  reader  such  ex- 
planations as  have  been  solved  to  date,  and  a  working  basis  for 
those  desirous  of  penetrating  deeper  into  the  processes  underlying 
natural  decay. 

Nutrition  of  Mother  and  Child.  By  C.  Ulysses  Moore,  M.  D., 
M.  Sc.  Instructor  in  Diseases  of  Children,  University  of  Oregon 
Medical  School ;  Medical  Director  of  The  Cooperative  Infant  Wel- 
fare Society  of  Oregon;  Pediatrist  to  the  Multoomah  County  Hos- 
pital and  the  Florence  Crittenden  Home,  Portland,  Oregon.  In- 
cluding Menus  and  Recipes.  By  Myrtle  Josephine  Ferguson,  B.  S., 
Professor  of  Nutrition,  Iowa  State  College,  Ames,  Iowa.  With  33 
Illustrations.  Philadelphia  and  London  :  J.  B.  Lippincott  Company. 
1923.    Cloth,  $2.00  net. 

This  book  is  written  in  a  popular  vein  which  renders  it  available 
to  the  laity  as  well  as  to  the  nurse.  It  is  more  of  a  guide  to  the 
proper  feeding  of  the  healthy  rather  than  the  sickly  child  and  lays 
especial  emphasis  upon  the  proper  dietary  applicable  to  the  normal 
rather  than  the  abnormal  infant.  Breast  feeding,  vitamins  and  the 
mineral  content  of  the  diet  are  particularly  stressed.  It  should  prove 
especially  helpful  to  nurses  and  social  workers  when  conducting 
short  courses  in  nutrition  for  mothers.  Any  intelligent  woman  can 
use  it  profitably  as  a  guide  to  the  proper  feeding  of  her  family. 

Ophthalmoscopy,  Retinoscopy  and  Refraction.  By  W.  A.  Fisher, 
M.  D.,  F.  A.  C.  S.,  Chicago,  111.  Professor  of  Ophthalmology.  Chi- 
cago Eye,  Ear,  Nose  and  Throat  College ;  Late  Professor  of  Clinical 
Ophthalmology,  University  of  Illinois ;  Late  Surgeon,  Illinois  Chari- 
table Eye  and  Ear  Infirmary.  With  248  Illustrations,  including  48 
colored  plates.    Chicago:    W.  A.  Fisher,  31  N.  State  Street.     1922. 

In  the  author's  opinion  ophthalmoscopy  and  the  fitting  of  glasses 
belong  to  the  general  practitioner,  and  acquirement  of  the  necessary 
practical  and  theoretical  knowledge  is  easy,  interesting  and  within 
the  reach  of  all.  He  has  therefore  written  this  book  with  the  inten- 
tion of  teaching  medical  practitioners  and  students  the  practical  use 
of  the  ophthalmoscope  and  retinoscope  in  the  detection  of  diseases 
of  the  interior  of  the  eye  and  for  the  fitting  of  glasses  when  needed. 
The  methods  proposed  are  sensible  and  practicable,  and  should  help 
the  student  materially  in  acquiring  the  art  of  making  a  complete  ex- 
amination of  the  eye.  He  is  to  be  congratulated  on  emphasizing  the 
importance  of  every  practitioner  of  medicine  making  himself  com- 
petent in  examination  of  the  eye-ground,  for  so  many  systemic 
diseases  are  first  mirrored  there.  It  gives  us  great  pleasure  in  recom- 
mending the  book  to  our  readers. 

I  Believe  In  God  And  Evolution.  By  William  W.  Keen,  M.  D. 
Emeritus  Professor  of  Surgery,  Jefiferson  Medical  College,  Phila- 
delphia. Philadelphia  and  London:  J.  B.  Lippincott  Company. 
Cloth,  $1.00. 


196 

The  main  gist  of  this  book  is  the  presentation  of  scientific  data 
obtained  from  the  operating  room  and  the  anatomical  laboratory  to 
substantiate  the  belief  of  the  distinguished  author  that  man  and 
beast  are  descended  from  the  same  remote  ancestor.  At  the  same 
time  he  asserts  that  this  opinion  in  no  wise  intereferes  with  his  be- 
lief in  the  existence  of  God.  In  fact  he  maintains  it  increases  his 
faith  in  a  supreme  deity.  Throughout  the  text  he  cites  many  ex- 
amples of  evolution  both  in  plants  and  animals  and  calls  attention 
to  the  similarity  of  the  structural  composition  of  man  and  animal 
to  support  his  theory.  In  other  words  religion  and  science  are  not 
antagonists  but  allies,  each  playing  an  essential  role  in  rendering  life 
better  and  happier  and  at  the  same  time  rendering  obeisance  to  the 
wondrous  handiwork  of  the  omnipotent  Father. 


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